Why Patient Access Teams Need Smarter Tools to Tackle Prior Authorization and Insurance Denials

Imagine starting each day facing hundreds of prior authorizations.

That's the reality for our doctors and patient access teams. PAs were initially meant to keep healthcare costs in check and ensure treatments are truly needed—but they often end up causing delays and denials.

This means patients often struggle to get the care they need, right when they need it most. With more and more PAs, patient access teams must have user-friendly tools to tackle these challenges without being overwhelmed.

In this article, we’ll explore the role of smart tools and AI in effortlessly handling prior authorizations and insurance denials.

How Prior Authorization Impacts Patient Access

Prior authorization processes have become a major burden for healthcare providers across the country. According to a survey by the American Medical Association (AMA), 94% of physicians reported that prior authorization often causes delays in patient care.

Even more concerning, 80% of physicians said these delays sometimes lead patients to abandon their recommended treatment entirely. This can result in worsening health conditions, unnecessary hospitalizations, and increased healthcare costs.

In addition to harming patient outcomes, the process places a heavy administrative load on healthcare teams. It takes time away from direct patient care and causes burnout among staff.

Administrative Burden and Its Consequences

The administrative tasks associated with prior authorizations are time-consuming and often require dedicated staff to manage.

A report by the American Academy of Family Physicians (AAFP) highlights that physicians and their staff frequently bear the brunt of patients’ frustration with PAs and the associated care delays. This extra burden can wear down healthcare workers, decreasing job satisfaction and worsening patient outcomes.

Why Today’s Tools Aren’t Enough

Many patient access teams are still relying on outdated tools like spreadsheets, emails, and fax machines to manage their workflows. While these methods may have worked in the past, they are no longer effective in today’s fast-paced healthcare industry.

These manual systems are slow, difficult to track, and prone to human error. They are nearly impossible to manage at scale, especially when dealing with high volumes of insurance claims.

Year after year, prior authorizations and denials keep increasing, putting extreme pressure on healthcare access teams. Without modern, efficient tools, patients face delays, staff get burned out, and opportunities to deliver care are lost.

The Need for Technological Solutions

Healthcare organizations are turning to technological solutions that streamline the prior authorization process. Electronic prior authorization (ePA) systems automate data exchange between providers and payers, reducing delays and administrative load.

According to CAQH, switching to ePA systems could reduce delays by 69% and save $494 million in healthcare costs annually.

Integrating Prior Authorization into EHR Workflows

Integrating prior authorization processes into electronic health record (EHR) systems can enhance efficiency. By embedding PA forms directly into the clinical workflow, physicians and staff can initiate authorizations during patient visits, minimizing administrative overhead.

This reduces redundant data entry and improves workflow efficiency—directly addressing a significant burden in the PA process.

Centralizing and Standardizing the Process

One effective way to manage prior authorizations is to centralize and standardize the process. Having a dedicated team or digital assistant handle submissions, follow-ups, and paperwork improves consistency and accountability.

With clear workflows, easy templates, and consistent payer communication, errors decrease and approvals improve.

Leveraging AI and Automation

AI and automation can be game-changers. Smart tools can:

• Extract details from documents
• Fill out lengthy forms
• Write appeal letters quickly
• Save time and reduce manual effort
• Cut down on human errors

It’s about making the process smoother and more efficient for everyone involved.

How Fight Paperwork Can Help

Fight Paperwork is AI software designed to ease the burden on patient access teams. It collects and organizes patient and denial data using smart automation.

It helps prioritize care by removing paperwork barriers. The platform uses generative AI to streamline appeal denials, automate processing, and reduce delays.

Simple dashboards make it easy to track trends and improve performance. The platform also includes Donut, an AI chat assistant that provides on-demand support and guidance—freeing up staff to focus on urgent care.

Policy Changes and Advocacy Efforts

Policymakers are catching on. CMS has proposed the Interoperability and Prior Authorization rule, which aims to reduce the burden of identifying required documentation and PA requirements.

The AMA also supports creating "Gold Carding" programs, which excuse providers with high approval rates from some prior authorization requirements—cutting red tape and saving time.

FAQs

1. What types of insurance denials can be appealed successfully?
Even denials due to missing information or coding issues can often be overturned. Tools like Fight Paperwork help uncover the reason and generate strong, timely appeals.

2. Do AI tools replace human staff in the appeals process?
No. Tools like Fight Paperwork support, not replace, patient access professionals. They reduce repetitive work so staff can focus on high-impact tasks.

3. Are there legal timelines insurance companies must follow for prior authorizations?
Yes. Most states require payers to respond within specific timeframes—often 72 hours for urgent cases. Knowing these deadlines helps teams track and follow up effectively.

Moving Forward with Smarter Solutions

Patient access teams are under more pressure than ever. But smart technology offers a path forward.

By weaving approval steps into existing clinical workflows, reducing paperwork, and leveraging tools like Fight Paperwork, healthcare providers can spend less time chasing forms—and more time with patients.

Safia Sheikh
Academic Researcher