Automating prior authorization is usually worth it for a specialty practice on DrChrono once the staff time spent on authorizations, plus the revenue lost to denied or delayed care, exceeds the cost of the tool. The math tips sooner for specialties with high authorization volume and a heavy share of medical-benefit requests, such as orthopedics, cardiology, and gastroenterology, because DrChrono's built-in ePA only covers prescriptions.
What does prior authorization really cost a specialty practice today?
Start with the time. The AMA's 2024 physician survey of 1,000 physicians found an average of 39 prior authorization requests per physician per week, consuming about 13 hours of physician and staff time. Forty percent of physicians reported having staff who work exclusively on authorizations.
Then add the per-transaction cost. The 2019 CAQH Index put a manual prior authorization at roughly $11 versus about $2 when fully electronic. Those numbers are several years old and don't capture today's labor costs, so treat them as a ratio rather than a budget. The manual path costs several times more per request.
The harder-to-see costs are downstream: scheduled procedures that slip because an approval hasn't landed, claims denied for missing authorization, and staff who burn out chasing payers. Those rarely show up on a single line of your P&L, but your administrator knows they exist.
What does DrChrono already automate, and what is left?
DrChrono's native prior authorization runs through its CoverMyMeds integration, announced in 2019, and covers prescription authorizations from the e-prescribing workflow. If most of your requests are drug approvals, you may already have most of what you need.
Specialty practices tend to look different. Imaging, procedures, infusions, DME, and referrals fall under the medical benefit, which runs through payer portals, phone calls, and fax. Those are the authorizations that consume the most hours, and they're what a separate automation layer targets.
What are your three options?
Most practices end up choosing among three paths.
Keep the status quo. No new spend, and no change in risk. Your cost is the staff time already being spent, plus whatever you lose to delays and denials. This works when volume is low and stable.
Hire. Add a dedicated authorization coordinator. Hiring is predictable and keeps judgment in-house, but it scales linearly: doubling volume roughly means doubling headcount. It also leaves you exposed to turnover, since the role is repetitive and stressful.
Automate. Add a tool that handles requirement checks, packet assembly, submission, and follow-up. Software scales with volume at a lower marginal cost, but it needs setup, monitoring, and a human exception process.
A hybrid is common: automate the high-volume routine work and keep one experienced coordinator for exceptions, peer-to-peer scheduling, and appeals.
How do you calculate the ROI?
Use a simple formula with your own numbers:
- Staff time saved = authorizations per month × minutes saved per authorization ÷ 60 × loaded hourly staff cost.
- Revenue protected = denied or delayed procedures avoided per month × average net revenue per procedure.
- Net benefit = staff time saved + revenue protected − monthly tool cost.
Here is an illustrative example with assumed numbers, not benchmarks. Suppose a specialty group handles 600 authorizations a month, automation saves 20 minutes on each, and loaded staff cost is $28 an hour. That's 200 hours saved, or about $5,600 a month. If automation also prevents five delayed or lost procedures a month at $1,500 each, add $7,500. Against a tool cost of, say, $4,000 a month, the net benefit would be roughly $9,100 a month. Change the assumptions and the answer changes, which is the point of running it with your actual figures.
Be conservative on time saved. Start with the minutes your staff measure now, not the vendor's claim, and review after a 60 to 90 day pilot.
What should make you hesitate?
Automation isn't right for every practice. Slow down if your volume is low enough that one part-time coordinator handles it comfortably, if most of your requests are drug authorizations already covered by CoverMyMeds, or if your payer mix is dominated by a few plans with unusual requirements that no tool supports well.
Plan for the things software can't do. Peer-to-peer reviews, clinical appeals, and unusual payer exceptions still need people. Change management matters too: staff need to trust the tool, know where the exception queue lives, and understand that their role shifts toward oversight.
How do you evaluate an AI agent for this work?
Ask for a pilot on a defined slice of your volume and measure two things: turnaround time from order to decision, and first-pass approval rate. Confirm how the tool connects to DrChrono, whether it handles medical-benefit authorizations, and what happens to requests it can't complete.
Honey Health's prior authorization agent is one example of this category. It works alongside your EHR, handling submission and follow-up, while your staff handle the exceptions. Whatever you choose, tie the contract to measurable outcomes rather than activity counts.
Frequently Asked Questions
How do you know if prior authorization automation is worth it?
Compare what you spend on authorizations now, in staff hours plus delayed or denied revenue, with the tool's total cost. If the monthly savings clearly exceed the cost during a short pilot, it's worth it. Higher volume and a larger share of medical-benefit requests make that more likely.
Does DrChrono already automate prior authorization?
Partly. It integrates with CoverMyMeds for prescription authorizations. Authorizations for imaging, procedures, and referrals aren't covered and usually run through payer portals, phone, and fax.
How long does it take to see a return?
Many practices evaluate results over a 60 to 90 day pilot. Time savings can show up within weeks, while improvements in approval rates and fewer delayed procedures take a full cycle or two to measure.
Is it better to hire a coordinator or automate?
Hiring scales linearly with volume and exposes you to turnover, while automation scales at a lower marginal cost but needs oversight. Many practices combine them, with automation for routine volume and one coordinator for exceptions and appeals.
What are the risks of automating prior authorization?
The main risks are a poor EHR fit, unsupported payers, and unclear handling of exceptions. Reduce them by piloting on a small slice of volume, confirming exception workflows in writing, and tracking turnaround and approval rates from day one.
