What a Single Prior Authorization Really Costs You

Practices treat prior authorization as an annoyance rather than a cost, largely because it never appears as a line item. It is staff time, and industry measurement puts manual processing at roughly eleven dollars per transaction.

Where the time goes

• Determining whether authorization is required for this code, this plan, this site of service.
• Assembling the clinical information the payer wants, in the form they want it.
• Submitting, and waiting — portal, fax, or phone with hold time.
• Following up on anything that pends, which is where most of the hidden time sits.
• Coordinating peer-to-peer review when it is requested.

The first and last of those are the expensive ones and the least visible in any workflow diagram.

Why the number matters

Because it sets the comparison. Outsourced prior authorization runs in a band that overlaps with what it costs to do manually in-house — so the decision is rarely a large saving in either direction. It is about capacity and consistency: whether the follow-up on pended requests actually happens when the person responsible is also running a front desk.

The number worth knowing

Authorizations per month, and average staff minutes each. Most practices have never counted, and the total is usually larger than expected — often more than a full-time role's worth spread invisibly across several people.

That figure is what makes the conversation concrete, whichever way it is resolved.