Prior authorization automation in DrChrono works through its CoverMyMeds integration, which starts and tracks electronic prior authorization requests for prescriptions from inside the e-prescribing workflow. Authorizations for imaging, procedures, and referrals sit outside that workflow and still run through payer portals, phone calls, and fax. Practices that want end-to-end DrChrono prior authorization automation typically add an AI agent layer for the medical-benefit side.
What does DrChrono's built-in prior authorization automation actually cover?
DrChrono's native electronic prior authorization (ePA) is built on a partnership with CoverMyMeds, announced in 2019. The integration targets prescription prior authorizations and surfaces drug pricing at the point of prescribing. The companies said at launch it could save up to 15 minutes per request.
DrChrono's support documentation describes an Auto-Start ePA feature designed to start requests without manual re-entry, handle exceptions, and track payer responses. There's also a retrospective ePA option for authorizations that come up after a prescription is already sent, plus prior authorization alerts inside the chart.
That's a real time saver for pharmacy authorizations. It is not a fit for most of the work that eats your authorization staff's week: MRI and CT orders, specialty procedures, infusions, DME, and specialist referrals. Those fall under the patient's medical benefit, and the payer rules, forms, and submission channels differ by plan.
What are the four stages of prior authorization automation?
Every automated authorization workflow, in DrChrono or anywhere else, moves through the same four stages. Knowing them tells you where a tool helps and where your staff still carries the load.
- Trigger. Something flags that an authorization is needed: an order, a prescription, a scheduled procedure, or a payer rejection. In DrChrono, prior authorization alerts and ePA prompts do this for prescriptions.
- Clinical data gathering. The system pulls diagnosis codes, notes, imaging, prior treatments, and labs that the payer's criteria require.
- Submission. The request goes to the payer through an electronic channel, a portal, or fax, formatted the way that payer wants it.
- Status tracking. Someone (or something) follows up until a decision comes back, then records the outcome in the chart and flags denials for appeal.
Native ePA automates most of these stages for drugs. For medical services, stages 2 through 4 are usually manual, and they're where the hours go.
How much time does manual prior authorization really cost?
More than most administrators estimate. The AMA's 2024 physician survey of 1,000 physicians found practices handle an average of 39 prior authorization requests per physician per week, consuming about 13 hours of physician and staff time. Forty percent of physicians said they have staff who work exclusively on prior authorizations.
The per-transaction math is just as stark. The 2019 CAQH Index put a manual prior authorization at roughly $11, versus about $2 fully electronic, with only 13% of transactions fully electronic at the time. Those figures are several years old and labor costs have risen since, but the ratio is the point: the manual path costs several times more than the electronic one.
How does a prior authorization actually move through DrChrono today?
For a prescription, the flow is short. A provider e-prescribes, the pharmacy or payer response flags a prior authorization requirement, and the CoverMyMeds integration opens the request with patient and drug details already filled in. Your staff reviews, answers any clinical questions, and submits. Status updates return to the chart.
For a medical service, the typical flow looks different:
- A provider places an order for imaging or a procedure.
- Staff checks the payer's requirements, often in a portal or by phone.
- Staff assembles clinical documentation from the chart and attaches it.
- Staff submits by portal or fax, then logs the reference number manually.
- Staff calls or checks the portal on a schedule until a decision arrives.
DrChrono lets you record pending authorization numbers and see payer pre-auth data on reports, which helps with tracking. The submission and follow-up work is still done by a person.
Where does manual work remain, even with automation?
Some pieces stay human, and a good implementation plans for them rather than hiding them.
Peer-to-peer reviews need a clinician on the phone with a medical director. No software replaces that conversation, though automation can prepare the case summary beforehand.
Payer-specific exceptions also persist. Payers change criteria, add plan-level carve-outs, and update portals without notice. Any automated workflow needs a human exception queue for requests the system can't complete confidently.
Appeals after a denial usually require clinical judgment about what additional documentation will change the outcome. Automation can draft and assemble; a person decides.
The honest framing for your leadership team: automation handles the repetitive 80% of the volume, and your staff's time shifts to the exceptions where judgment matters.
How do AI agents extend DrChrono's prior authorization automation to medical services?
An AI agent works alongside the EHR rather than replacing it. It reads the order and the chart, identifies the payer's requirements, assembles the clinical packet, submits through whichever channel that payer accepts, and checks status on a set cadence. When a decision comes back, it writes the result into the record and routes denials to a person.
This is the pattern Honey Health's prior authorization agent follows for practices on DrChrono and other EHRs. The EHR stays the system of record, and the agent handles the portal navigation, form completion, and follow-up that your staff would otherwise do by hand. The pairing makes sense for practices where medical-benefit authorizations outnumber pharmacy ones, which is common in specialties like orthopedics, cardiology, neurology, and gastroenterology.
When you evaluate any tool for this, ask four questions: Does it cover medical-benefit authorizations or only pharmacy? How does it connect to DrChrono (API, integration, or screen-level automation)? What happens to requests it can't complete? And how is turnaround time measured and reported?
Frequently Asked Questions
Does DrChrono have built-in prior authorization?
Yes, for prescriptions. DrChrono integrates with CoverMyMeds so providers can start and track electronic prior authorizations from the prescribing workflow. Medical-service authorizations such as imaging and procedures aren't covered by that integration and typically need a separate process or tool.
What is the difference between ePA and full prior authorization automation?
ePA usually means electronic submission of a pharmacy prior authorization through a network like CoverMyMeds. Full automation covers the whole cycle across both pharmacy and medical benefits: detecting the need, gathering clinical documentation, submitting, tracking status, and recording the outcome.
Can prior authorization be fully automated?
Not entirely. Routine requests with clear payer criteria can run end to end without staff touching them. Peer-to-peer reviews, unusual payer exceptions, and appeals still need people. Most practices aim to automate the high-volume routine work and route the rest to a trained staff member.
How long does a prior authorization take?
It varies by payer and service. Electronic pharmacy requests can resolve within a day or less, while medical-service requests submitted by portal or fax can take several days or longer, especially when additional documentation is requested. Consistent follow-up on a fixed cadence shortens the tail.
Do I need to change EHRs to automate prior authorization?
No. AI agents and automation tools are built to work alongside your existing EHR. DrChrono stays your system of record while the tool handles submissions and status checks, and the outcomes are written back to the patient chart.
