What Is Prior Authorization? The Ultimate Checklist for 24-Hour Turnarounds
Tired of waiting days—or even weeks—for insurance approvals? On average, prior authorization takes 3 to 10 business days, delaying care and frustrating patients. So, what is prior authorization, and why does it cause so many slowdowns? The good news is that with the right prior authorization checklist and smarter workflows, providers can overcome authorization barriers and move toward 24-hour prior authorization turnarounds that keep care moving.
What Is Prior Authorization?
Knowing what is prior authorization helps providers set expectations, prepare documents, and anticipate payer requirements. Prior authorization is the approval required by insurance companies before they agree to cover specific services, procedures, or medications. In other words, providers need to get the green light from payers before delivering certain types of care.
When is prior authorization required? Typically for high-cost imaging (MRI, CT scans), specialty medications, surgeries, or treatments deemed non-standard.
Why do payers require prior authorization? To verify medical necessity, reduce unnecessary costs, and ensure compliance with plan benefits.
Who is affected by the prior authorization process? Physicians, clinics, hospitals, patients, and billing teams that manage reimbursement. Without proper authorization, claims are denied, leaving both providers and patients stuck with delays and unexpected costs.
According to CMS (Centers for Medicare & Medicaid Services), prior authorization is designed to verify medical necessity, control costs, and ensure compliance with benefit policies.
Types of Prior Authorization Requests
Prior authorization requests vary by service, and each category has its own rules and documentation needs. Knowing the main types helps providers submit requests more efficiently and reduce delays.
Prescription Medication Prior Authorization
Prescription prior authorization is needed when medications fall outside standard coverage lists. Consequently, patients often wait while providers submit details.
Medical Procedure Prior Authorization
For surgeries or treatments, medical prior authorization verifies necessity. Comparatively, this type can take longer because it requires detailed clinical documentation, as explained in how long prior authorization takes for medications.
Imaging and Lab Test Prior Authorization
CT scans, MRIs, and advanced labs usually need insurance prior authorization. Similarly, insurance companies check if less expensive tests could be used first.
What are the Common Delays in Prior Authorization
Waiting days—or even weeks—for prior authorization approvals often leads to a chain reaction of problems within healthcare practices. Delays can result in:
Revenue loss: When authorizations are delayed, reimbursements are pushed back, slowing down payments.
Patient dissatisfaction: Patients may cancel or postpone care while waiting for prior authorization approval.
Provider burnout: Staff spend valuable hours on endless calls, faxes, and payer portals instead of patient care.
Denials and rework: Even small errors or missing documents in the prior authorization process can trigger denials.
Because of these setbacks, many forward-thinking practices are shifting toward faster solutions—making 24-hour prior authorization services the new benchmark for efficiency.
The Ultimate 24-Hour Prior Authorization Checklist
To achieve lightning-fast prior authorization turnaround times, every step must be proactive and optimized. Use this prior authorization checklist as your guide:
Step 1: Pre-Verification
Confirm patient eligibility and benefits before scheduling.
Check the payer’s eligibility verification and prior authorization requirements (some procedures may be exempt).
Step 2: Gather Documentation Early
Clinical notes, diagnosis codes (ICD-10), and CPT/HCPCS codes.
Supporting medical necessity documentation.
Lab results, imaging reports, or physician’s statement.
Step 3: Submit via the Right Channel
Use payer portals or ePA (electronic prior authorization) systems to avoid fax delays.
Ensure forms are complete—missing one field can cause rejection.
Step 4: Assign Clear Ownership
Designate a PA specialist or team so requests don’t get lost in the shuffle.
Create a standard operating procedure (SOP) for consistent handling.
Step 5: Follow-Up Within Hours
Don’t wait—contact payers within the same day to confirm receipt.
Document every interaction (date, time, rep name, reference number).
Step 6: Error-Proof Submissions
Double-check patient demographics and codes.
Verify prior authorization numbers before claim submission.
Step 7: Establish an Appeal Protocol
Have templated letters ready for fast resubmissions.
Track common denial reasons and fix them proactively.
Pro Tips for Achieving Faster Approvals
Maintain a payer cheat sheet with insurer-specific prior authorization guidelines.
Automate wherever possible with RCM technology and ePA systems.
Train staff regularly on changing insurance prior authorization policies.
Track KPIs such as average approval time, denial rates, and turnaround success.
How MBW RCM Helps You Achieve Faster Prior Authorizations
MBW RCM supports practices with dedicated prior authorization services designed to reduce delays and improve approval rates. Our billing experts use payer-specific knowledge and automation tools to lower denials, handle follow-ups, and streamline the prior authorization process. This way, providers can focus on patient care while benefiting from smoother operations and reliable approvals.
So, what is prior authorization really about? It is often viewed as a hurdle, but with the right approach it becomes a manageable part of the care process. By applying structured checklists, using technology, and relying on dedicated prior authorization services, practices can reduce delays, improve approval rates, and keep the focus on delivering timely patient care.
Partnering with experienced RCM providers further strengthens the process, helping practices stay efficient while supporting better outcomes for patients.
👉 Don’t let prior authorizations slow your practice. Contact MBW RCM today to discover a smarter way to secure faster approvals and keep patient care moving.
