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Preventing Prior Authorization Mistakes: Essential Strategies and Best Practices

Unlock the secrets to hassle-free healthcare administration! Learn the top strategies for preventing prior authorization mistakes and ensure smooth, error-free processes. Read on to find out how.

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It is crucial to know if does medicare require prior authorization for surgery. Yes, especially for surgeries covered by medicare advantage plans, medicare does demand prior authorization. This condition guarantees that the procedure is both covered by the patient’s plan and medically necessary. Healthcare professionals must get this authorization in order to avoid unforeseen expenses and delays in patient care.

Let’s investigate ways!

Table of Contents

Preventing Prior Authorization Mistakes

preventing prior authorization mistakes medical servicesGetting approval is a sometimes complex process in healthcare. It entails getting the green light from a patient’s insurance provider before proceeding with medical services, ensuring that the treatment falls within their coverage. However, this stage is riddled with issues that can cause treatment delays, higher expenses, and added administrative tasks for healthcare professionals. In this piece, we’ll delve into the five mistakes made in authorization and provide practical tips on how to avoid them.

Error 1: Insufficient or Incorrect Documentation

Submitting inaccurate paperwork during the authorization procedure is a prevalent misstep. This can result in denials or treatment delays, posing risks to patients’ well-being and causing frustration for all parties involved. Healthcare providers must verify they have all the required information and documents before requesting approval. This includes details, pertinent medical records, and supporting evidence for the requested treatment or procedure.


Only complete or correct documentation can help patient care by stalling treatments. Furthermore, it can escalate tasks due to the need for resubmissions and appeals.

Common Mistakes:
  • Omissions in information.
  • Inaccurate medical codes.
  • Absent signatures.
  • Incomplete medical background.
Here are some ways to prevent errors:
  • Create a checklist for documentation.
  • Review all forms for accuracy before submitting them.
  • Use software to assist with coding and submission.
  • Provide staff training to keep them informed about documentation needs.

Error 2: Not Confirming Insurance Coverage

Verifying a patient’s insurance coverage before starting the authorization process is crucial. Please do so to avoid wasted time and delays if the patient isn’t covered for the requested service.


Failing to confirm coverage can result in work and potential financial losses for the healthcare provider and the patient.

Common Mistakes:
  • Missing changes in insurance plans.
  • You are assuming coverage based on visits.
  • You need to understand insurance plan specifics.
Prevention Measures:
  • Always check insurance information during each encounter.
  • Use tools for verification to simplify the process.
  • Train staff on understanding insurance plan intricacies.
  • Maintain an updated database of insurance plans and their prerequisites.

Error 3: Misinterpreting Payer Requirements

Different insurers have rules and requirements for authorizations. Misunderstanding these criteria could lead to denied requests and care delays.


Errors or misunderstandings in payer requirements can cause delays, resulting in dissatisfaction and potential harm to patient well-being.

Common Mistakes:
  • Failure to stay updated on payer policy changes.
  • We are submitting requests.
    Misinterpreting policy terms.
Preventive Measures:
  • Regularly check payer policies and updates.
  • Establish a repository with payer guidelines.
  • Train staff on interpreting and applying payer policies accurately.
  • Maintain communication channels with payer representatives to clarify any uncertainties.

Error 4: Submission Delays

preventing prior authorization mistakes tired doctor

Timeliness plays a role in the authorization process. Submissions must be completed on time to avoid treatment delays, which negatively impact patient outcomes and satisfaction.


Delayed submissions can worsen conditions and increase stress levels for patients awaiting treatments.

Common Mistakes:

  • They need to start gathering the required documents.
  • Need to prioritize requests.
    Inefficient workload management.
Prevention Strategies:
  • Set protocols for prioritizing and managing authorizations efficiently.
  • Utilize software tools for monitoring and handling submissions.
  • Assign staff members to handle authorization requests promptly.
  • Implement a system to track submission deadlines and send reminders.
What Our Clients Say About Us!
Victoria Nutting D.O.

I'm very thankful for Portiva who I know is looking after my practice while I'm gone the virtual assistants can manage prescription refills, documents they can triage patients and just kind of answer administrative questions and they can handle a lot on their own. But also, they're very good about contacting me if there's any emergency or anything I need to attend to. So I'm very thankful for Portiva they can help almost any provider almost anywhere and it really allows for some good work-life balance as I'm getting to experience right now at my family farm so I'm very thankful for Portiva and I'm very happy to use their services"

victoria nutting do
Victoria Nutting D.O.

Board Certified Family Medicine Physician

100 satisfaction
Mohammad Ashori, M.D.

Portiva's Virtual Medical Assistant - I have all the support I need. There's somebody checking my email, any patient messages. Patients are still able to schedule and handle any scheduling issues and any kind of billing that needs to still go through. Portiva hands handles it all for me. I have support i have somebody that I can access 24/7 pretty much. It's all very seamless. If somebody has an emergency or needs a medication called in. I know that the va's at portiva will handle that for me.

mohammad ashori md
Mohammad Ashori, M.D.

Board Certified Family Medicine Physician

100 satisfaction

Error 5: Lack of Follow-up

preventing prior authorization mistakes sad young doctorNeglecting to follow up after submitting the required documents can lead to missed denials or requests for more information, causing further delays in the authorization process.


Failing to follow up can leave authorizations in a state of uncertainty, create inefficiencies, and have a negative impact on patient care timelines.

Common Mistakes:

  • Assuming that submission automatically means approval.
  • I need to consider follow-ups for pending authorizations.
  • I need to track submission records.
Preventive Measures:
  • Utilize tracking tools to keep tabs on the status of all authorization requests.
  • Set up automated reminders for follow-ups.
  • Maintain records of all interactions with payers.
  • Assign a team to manage follow-up tasks until authorization is confirmed.

Closing Thoughts

Prior authorization is a vital process that significantly influences patient care and healthcare operations. Recognizing and avoiding errors like documentation, failure to verify insurance, misunderstanding payer criteria, late submissions, and insufficient follow-up, healthcare providers can ensure a smoother and more effective prior authorization procedure. Implementing these strategies will not enhance patient care. It also boosts overall operational efficiency.

Proper prior authorization is essential for delivering quality healthcare and enhancing patient outcomes. That’s why assessing and enhancing the procedure to prevent errors and guarantee prompt approvals for essential treatments is crucial. It’s important to keep up with evolving policies and demands from payers and consistently educate staff to ensure a seamless prior authorization process for optimal patient care. Let’s collaborate on enhancing the authorization procedure and delivering top-notch care for our patients. Thank you for your attention! Enjoy coding and submitting your work!

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