We all know that prior authorization has become an inevitable part of any healthcare insurance billing process. 

The truth is that Medicare Advantage itself handled almost 50 million PA requests in 2023- a sharp increase from 2022. The positive thing is that almost 90% of those requests were approved, but the number of denials is also not small enough to ignore. It was almost 3.2 billion denied PA requests. And as a result each of these PA denials causes care delays, a tedious appeals process, and sometimes patients are left with abandoned care. 

With such high volume, prior authorization has become a daily hurdle for many physicians and health systems. 

You might have already realized that denials in prior authorization services have become a serious problem for many healthcare providers across the nation. Let’s explore some critical PA denials data- 

An overview of prior authorization service denials: 

Denials not only slow down care but also strain healthcare staff and systems. In 2023 alone, 81% of prior authorization requests under Medicare Advantage plans were fully denied. Appeals can reverse decisions, but they take time, time that could be spent on patient care. Most providers face growing pressure from these complex tasks while dealing with limited staff. That’s where prior authorization services come in. Expert prior authorization services help reduce errors, manage denials, and handle appeals faster. You can always save time and ensure timely care for patients by outsourcing your PA services. 

However, you can only understand how a professional PA service helps you when you know about the challenges. 

Vital challenges of prior authorization services – 

Surge in PA volume and ongoing staff shortage: 

Prior authorization requests keep rising every year, and the trend isn’t slowing down. In a 2021 AMA report, 84% of doctors said they now face more prior authorization requirements than they did five years ago. At the same time, hospitals and health systems struggle with staff shortages. A survey by AKASA showed that over 57% of them have more than 100 open positions. 

It clearly shows that most practices have very limited human resources to handle the PA nuances, thus causing delays and stress. Here is an example for you —a mid-sized hospital in Ohio had to delay patient treatments. The reason is simple—they could not keep up with PA volume. Patient care always suffers, and burnout increases with fewer hands and mounting paperwork. 

Continuously changing payer rules: 

Another major issue with prior authorization is the constantly changing payer rules. Insurance companies update their requirements often, and each patient’s health plan can be different. A 2021 MGMA poll found that rules are inconsistent across payers, often unclear, and change frequently. This makes it hard for healthcare staff to keep up. When they miss something or don’t follow the latest rule, approvals get delayed or denied. The more confusing the process, the longer it takes, and the more denials providers face. 

Lack of transparency: 

Changing payer rules isn’t the only issue—lack of clear information from payers is also a big problem. A 2021 AMA survey found that 62% of doctors struggle to figure out if a medical service even needs prior authorization. Some payer portals help by letting you check requirements using just a CPT code. But others force you to call and verify patient benefits, which wastes time. For example, a clinic in Texas had to delay a surgery because the payer didn’t list prior auth rules online. The staff spent hours on calls just to confirm if approval was needed. Since payers and providers often don’t work with the same goals or systems, getting an approval quickly becomes even harder. 

The tedious nature of PA tasks: 

Prior authorization takes a lot of time and effort. It starts with collecting patient and procedure details, then moves to submitting the request to the payer. If anything is missing or wrong, it leads to delays and more back and forth. After submission, staff must follow up to check the status, which alone takes over 12 minutes. Outdated tools like phones and faxes make things worse. Many providers still use these instead of faster electronic systems, which leads to delays and missing information. For example, the whole process stops when a fax doesn’t go through, or a call is missed. Each step—initiation, submission, and follow-up—adds more time and stress to an already busy staff. 

Excessive administrative hassles and staff burnout: 

Healthcare workers are under a lot of stress. About 93% say they feel stressed, and most are tired and burned out. Rising patient numbers and staff shortages are part of the problem, but the work itself adds to it. Prior authorization is one of the biggest stress points. The rules are complex, and the number of requests keeps growing. It’s hard for staff to manage it all. In fact, 88% of doctors say the burden of prior auth is very high. Every request takes time, needs follow-ups, and adds pressure to an already stretched team. For example, one nurse might spend hours just tracking approvals, leaving less time for patient care. The workload never seems to slow down, making burnout worse every day. 

Inefficient benefits and eligibility process: 

Prior auth denials don’t always happen because of coverage issues, wrong codes, or late submissions. Many times, the problem starts with simple mistakes in checking benefits and eligibility. The whole prior authorization process can be slowed down because of the wrong patient or insurance information and using the wrong PA form. Sometimes, you may also receive late PA approval. A little mistake that happens at the initial stage could create a big issue later in the process. 

Outdated technology: 

Prior authorization already takes a lot of time. Even though there are tools to make it faster, many healthcare organizations don’t have the right technology. About 62% of providers can’t check prior auth requirements before they start a request, and only 45% of vendors offer tools to help with this. Switching to electronic prior auth could save around 17 minutes per request. But still, only 26% of prior auths are fully electronic. Most are done with outdated methods, which adds to delays and extra work for staff. 

Have you already started scratching your head thinking about all the challenges mentioned above? Just don’t worry, as you can always navigate all those pitfalls with the right prior authorization service provider. 

SunKnowledge: Your reliable prior authorization service partner 

At SunKnowledge Inc., we take the stress out of prior authorization by managing every step of the process with precision and speed. We do it all—from checking eligibility to submitting PA requests and handling follow-ups. Our team uses advanced electronic prior authorization (ePA) tools like CoverMyMeds and Availity to cut down on delays and boost approval rates. We understand payer rules, keep up with changes, and ensure complete and accurate submissions. With our end-to-end prior authorization services at just $7 per hour, you get expert support, faster approvals, and more time to focus on patient care. Let us handle the complexities while you enjoy peace of mind.