- October 5, 2026
- Posted by: Josh Knoll
- Category: Prior Authorization
Prior authorization backlogs never arrive as one single dramatic operational failure. They are a gamut of small lapses such as an incomplete chart, an unanswered payer call, or a missed follow-up. With time, these small lapses tend to accumulate and begin affecting the procedures that have been scheduled, which can affect the revenue cycle as well.
In most such cases, the healthcare organization in question resorts to hiring more people. Then again, recruitment is not a straightforward road to anywhere. It takes time, and even if the onboarding was short, an organization still needs time for training the newly hired help. Therefore, more and more people are roping in external help because of the said feasibility and convenience.
Organizations that choose to outsource prior authorization services tend to bypass the onboarding formalities, and as a result, produce results without any hassle. Follow along to learn how an external PA service can help providers deal with aging request backlogs.
When Does a Pending Authorization Become an Aging Request?
In all honesty, there is not a single point where an aging claim turns into a problem area. Every specialty has its own definition of what entails an aging request. For instance, an imaging record might have a bracket of 2 weeks, while an oncology provider might have a bandwidth of one week. The difference in this definition is based on unique components such as clinical urgency, payer deadline, appeal window, missing information, etc.
For operational purposes, specialties tend to divide their open inventory into aging buckets such as:
- 0 to 2 days: Falls under the normal intake and submission period.
- 3 to 5 days: The request requires confirmation, payer follow-up, or missing documentation review.
- 6 to 10 days: Elevated-risk cases that might threaten scheduling or the expected turnaround of a practice.
- More than 10 days: High-risk requests that need immediate cognizance and action.
Even though this classification can be helpful, it cannot be a one-size-fits-all situation. Providers need to approach this aspect from where they are standing.
Related Reading: Prior Authorization Support Like Never Before: Leverage the Sunknowledge Opportunity
Why Authorization Backlogs Keep Growing
A backlog generally can be attributed to a capacity problem or a workflow problem. In some cases, it can be both. Therefore, seeing the whole thing as something unilateral is not something that can be fruitful. Here is a rundown of some of the most common causes behind authorization backlogs.
Incomplete Clinical Documentation
One of the most common reasons behind authorization backlogs is incomplete documentation. In other words, payers might hold up payment when the submission lacks necessary details such as recent test results, conservative treatment history, medical necessity of the procedure, etc.
Therefore, one of the most common and sure-shot ways to handle this is to let outsourced prior authorization services take over. They can employ processes such as triple checks in order to ensure that no documentation is incomplete.
Fragmented Payer Follow-Up
The primary work of prior authorization services can be best defined as fragmented. This means that a request can be submitted through one single channel but can be updated or adjudicated via another. Therefore, there is a higher scope of repeated requests for a single service line, which can further delay the entire procedure.
Another aspect in this case is the payer rule variation. Every payer could approach a specific line of service or procedure differently. Therefore, using artificial intelligence to create a system without any form of human intervention could be problematic, since manual recording is the only way billers can keep tabs on the variations.
Staffing Gaps and Uncontrolled Incoming Volume
Last but not least, the staffing gap is another reason that could trigger authorization backlogs. Providers who primarily rely on an internal team might face this more than the team that has decided to outsource prior authorization services.
The reason is that most internal teams are torn between different job roles, where a person is taking care of scheduling as well as denial management. This is one of the reasons behind blatant human errors in claim formation. Therefore, having omnipresent billing support can help providers handle this situation.
How Outsourcing Turns a Backlog into a Managed Recovery Project
The decision to outsource to an external billing team is not equivalent to buying groceries. Providers need to understand what an outsourced prior authorization partner offers. Here is a look at what outsourced billing support offers:
Inventory Validation and Duplicate Removal
Professional prior authorization services begin the process with a clear understanding of the request across different platforms. This helps providers have a better look at the whole thing and understand whether a service line has been approved, cancelled, or billed twice.
Risk-Based Prioritization
Most providers tend to approach the whole thing on an oldest-first basis. This can be helpful, but it might not be as fruitful as risk-based prioritization. In the latter format, providers prioritize requests based on:
- Clinical urgency
- Scheduled service date
- Payer response or appeal deadline
- Age of the request
- Authorization expiration risk
- Revenue exposure
- Availability of supporting documentation
This helps the billing team handle roadblocks with a clearer understanding. Subsequently, it protects revenue with the help of enhanced visibility.
Parallel Cleanup and Current-Volume Teams
One of the largest missed opportunities in backlog recovery is using the same team for both old and new work. A better model assigns one workstream to the aged inventory and another to incoming requests. Having two separate teams can be helpful as none of the work would end up bleeding into another. Therefore, compartmentalization is one of the sure-shot ways of keeping work separate.
Documented Ownership and Escalation
Finally, outsourced prior authorization services also help providers have a clear path of escalation and ownership. In simple words, if a billing team understands who owns which part of the RCM, then the confusion could be much less. Therefore, established PA services tend to have a clear understanding of who is responsible for what.
Related Reading: How Prior Authorization Services Prevent Post-Approval Claim
A Sustainable Way Forward
Authorization backlogs are not isolated. In other words, their area of damage is much broader than people anticipate. They have the capability to interrupt treatment, take up too much clinical time, and create a disconnect between the verticals.
Hence, it is high time providers look towards outsourcing. Outsourcing prior authorization services to a partner such as SunKnowledge does not just bring in billing expertise, but a sense of structure with the help of our esteemed team of billing experts that have over 15 years of experience in the domain.
Get on the call today and fix all your billing problems with the right guidance.