Prior authorization (PA) is a critical step in the revenue cycle, yet it’s also one of the biggest sources of payment delays, denials, and lost revenue for healthcare providers. At e-care India, we’ve seen firsthand how small missteps in the PA process can lead to big financial consequences.
In this article, we’ll highlight the
most common prior authorization mistakes that impact reimbursements, and
how you can avoid them with the right systems, staff, and support.
1. Submitting Incomplete or Inaccurate Information
One of the top reasons prior
authorizations are denied or delayed is missing or incorrect patient or
clinical information.
Common
errors include:
- Wrong CPT or diagnosis codes
- Missing medical documentation
- Incorrect patient demographics
- Incomplete justification for medical necessity
How
to avoid it:
Use a detailed checklist and train staff to verify all data before submission.
Better yet, partner with a billing service like ours that performs multi-level
checks to ensure accuracy the first time.
2. Failing to Verify Authorization Requirements
Every insurance plan has its own
list of services that require prior authorization and these can change frequently.
Submitting a request when one isn't needed, or failing to submit one when
required, results in denials and reimbursement issues.
How to avoid it:
Stay updated with each payer’s guidelines and maintain a real-time
authorization requirement database. Our billing specialists constantly
monitor payer portals and alerts to ensure your team is working with the latest
information.
3. Delayed Submissions and Missed Deadlines
Some authorizations must be
requested within strict time windows. Waiting too long to submit can
result in denied claims even if the service was medically necessary and
properly documented.
How to avoid it:
Implement a proactive workflow where authorizations are initiated as soon as a
service is scheduled. With our services, we track PA turnaround times and
ensure nothing slips through the cracks.
4. Lack of Follow-Up on Pending Requests
Payers may request additional
documentation or clarification before approving a PA. If your team isn’t
following up regularly, the request can sit in limbo, or worse, get denied due
to lack of response.
How to avoid it:
Assign a dedicated team or outsource to billing professionals who handle daily
follow-ups, escalations, and resubmissions as needed. Our specialists
handle this end-to-end, so providers can focus on patient care.
5. Not Documenting Authorization Properly
Even when authorization is approved,
failing to document the authorization number, expiration date, and approval
details in your system can result in denied claims later on.
How to avoid it:
Ensure all PA approvals are logged into your EHR or billing system with
accurate, searchable records. We maintain detailed documentation logs
for every authorization to support clean claim submission and faster payment.
6. Relying Too Heavily on Manual Processes
Manual faxing, phone calls, and
handwritten notes increase the risk of human error, lost paperwork, and
tracking failures.
How to avoid it:
Implement electronic prior authorization (ePA) wherever possible, and
use automation tools that integrate with your EHR. Our team leverages both
automation and human expertise to ensure efficient, error-free PA management.
7. Failing to Track Authorization Status and Expiration
Many PAs are only valid for a
certain timeframe. If services are rendered outside of that window, or the
authorization expires without being renewed, the claim will be denied.
How
to avoid it:
Set up reminders and alerts for authorization expiration dates. At e-care India, we track the full PA lifecycle to make sure nothing gets missed.
About e-care India
At e-care India, we have been offering end to end prior authorization services to physicians, medical specialties, medical groups to enhance revenue by reducing denials, accurate coding and faster reimbursements. We can save you cost up to 40%.
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