Provider Solution
Reducing the Burden of Prior Authorization
For many physicians, prior authorizations place a tremendous administrative and financial burden on care delivery. Further, the delay in care from having to obtain prior authorizations (PAs) puts their patients at medical risk. FHIR-based, electronic prior authorizations provide a viable solution that can significantly reduce the PA administrative burden for providers.
A study by the American Medical Association survey of 1,000 physicians found:
-
Practices spend an average of 16 hours each week completing PAs
-
Two in five physicians have a dedicated staff who handles PAs

Key Challenges
-
Confusion as physicians often do not know if a service requires PA
-
Time spent calling the payer to inquire if a service requires PA
-
Resources spent calling to request a PA, faxing supporting documentation and calling back for a status of their request
-
Decision wait time can be long resulting in delay in patient care
-
Determinations are not clear
A study initiated by AHIP, the nation’s leading healthcare advocacy organization found that physician practices experience marked reduction in the administrative burden from electronic PA.
Key Opportunities
Practices can reduce the administrative burden by 69% or more through FHIR-based electronic PAs that decreases submission time between 12-17 minutes per request.
-
Convenience of submitting PA requests at the point-of-care
-
Automation of patient eligibility and coverage determinations using FHIR-based CDS Hooks and CRD
-
Clear understanding of PA requirements and determinations
-
A fast turnaround from enabling complete patient, provider and clinical data points
-
Real-time status tracking of case history and decisions
Ready to save? Click here to learn more about Smile's Prior Authorization solution.
References
1. American Medical Association (2022). 2021 AMA prior authorization (PA)
physician survey https://www.ama-assn.org/practice-management/prior-authorization/prior-authorization-research-reports
2. RTI International Center for Health Care Advancement (February 25, 2022). Evaluation of
the Fast Prior Authorization Technology Highway Demonstration Final Report https://www.ahip.org/documents/Fast-PATH-Evaluation.pdf
3. Fierce Healthcare (January 22, 2020). Costs of prior authorizations increase for physician practices at an 'alarming' rate
https://www.fiercehealthcare.com/practices/costs-prior-authorizations-increase-for-physician-practices-at-alarming-rate
*Based on a CAQH study.