Patients Start Treatment Sooner When Every Prior Auth Is Chased Daily
Treatment starts sooner when the AgentWorks Prior Authorization Agent is on the case: it checks every pending authorization every day, answers the patient who calls asking where their approval stands, and books the peer-to-peer review before a denial stalls the case. The person it frees is your prior authorization coordinator — usually a medical assistant or front office lead who carries the payer work on top of a full clinic day.
What it takes off your plate
Talk to the coordinator and she will describe her day in portals. An order comes in for an MRI or a specialty medication. She pulls the progress notes, the imaging history and the medication trials from the chart, finds the payer's form, fills it in and uploads it to that payer's site. The next order goes to a different payer with a different form and a different portal.
The submission is only the start. Then comes the checking back: logging in to see whether a request moved, catching a request for more records, and trying to find a slot for the physician to speak with the payer's medical director. Meanwhile the patient calls, and calls again, wanting to know when the procedure can be scheduled. The AMA survey found that practices complete an average of 39 prior authorization requests per physician, per week, and every one of them needs that follow-through.
What it costs is the coordinator's attention. She is on hold with a payer while a patient waits at the window, and time-sensitive care waits on a status nobody had time to check.
What the Prior Authorization Agent does, step by step
The Prior Authorization Agent starts with the communication, because that is where the day leaks away.
- Tells the patient where things stand. When an authorization is submitted, the agent texts or emails the patient that the request is with the payer and what happens next. When the status changes, the patient hears about it without calling the office.
- Chases the payer every day. It checks the status of every open request daily and reads each response. A request for more documentation gets answered with the records the payer asked for, not left for the next login.
- Requests the peer-to-peer early. When a payer signals a review, the agent requests the peer-to-peer, offers times from the ordering physician's calendar and confirms the slot with both sides.
- Confirms the approval and books the care. Once approval arrives, the agent notifies the patient and hands the case to scheduling with the authorization number attached.
Then the data work, in the order it happens:
- Gathers the clinical documentation the payer requires for that service: progress notes, diagnosis codes, prior treatments and imaging.
- Completes the payer-specific form and checks it against that payer's requirements before anything is sent.
- Submits through the correct portal for that insurance company.
- Prepares the peer-to-peer summary so the physician walks into the call with the case on one page.
Where the work is recorded
The Prior Authorization Agent writes every step where your people already look. On the patient's record in the CRM, the office sees each message to the patient, each payer contact and each status change, in order. When a patient calls the front desk, whoever answers sees the latest status and the next step, and picks up exactly where the agent left off.
In the practice software, the authorization sits on the order with its status, the approval number once issued and the documents that were submitted. The next morning the coordinator opens one list: approved and ready to schedule, pending with the date last checked, more information requested, and peer-to-peer reviews booked with the physician's time. Denials land in the same list with the payer's stated reason, ready for a person to decide on appeal.
What your people do instead
The coordinator stays with the patient at the window. She explains a care plan, helps a family sort out a referral, and answers the question a worried patient asks in person. Medical assistants room patients without stepping out to take a payer call. The physician gets a peer-to-peer on the calendar with the chart summary ready, instead of a callback during clinic.
That is the division of work. The AgentWorks Prior Authorization Agent carries the forms, the portals, the daily status checks and the patient updates; your people give their time to the patients in front of them, where satisfaction is actually earned. For a closer look at the payer submissions themselves, read how a prior authorization agent works the payers while you see patients. Clean documentation shortens every request, which is why a documentation agent that drafts the note during the visit pairs well with this one.
One next step
If authorizations are the queue your staff dreads most, check whether they are the right first job for an agent in your practice. The free healthcare Industry Assessment shows which workflow an agent should take on first. To see the full set of workflows for medical practices, visit the AgentWorks healthcare page.
See where the Prior Authorization Agent would start in your healthcare business.
I'm Dr. Mitchell, the Healthcare ambassador here. The free Industry Assessment reads your website and asks how calls, follow-ups and records happen today, then shows the first workflow worth handing to an agent like this one — and what your team gets back. Leave your email and I'll send the link.
Dr. Mitchell replies from healthcare@agentworksstudio.com. One email with the link — no list, no drip, unless you ask for the weekly letter. Or go straight there →