The fastest way to reduce prior authorization delays and denials when your EHR is DrChrono is to check authorization requirements before the visit is scheduled, submit complete payer-specific documentation the first time, and follow up on a fixed cadence instead of waiting for a denial. Practices that standardize those three habits, and automate the repetitive submission and status-check work, cut turnaround time and stop losing approvable requests to missing paperwork.
Why do prior authorizations get delayed or denied in the first place?
Most delays trace back to a handful of avoidable causes: the practice didn't know an authorization was required until the claim came back, the clinical documentation was incomplete, the request went to the wrong payer channel, or nobody followed up when the payer went quiet.
The scale of the problem is large. The AMA's 2024 physician survey found practices handle about 39 prior authorization requests per physician each week, taking roughly 13 hours of physician and staff time. When volume is that high, small process gaps turn into daily backlogs.
Denials are more fixable than they look. KFF's analysis of 2025 payer-reported data shows about 13% of standard Medicare Advantage requests were denied, 14% in Medicaid managed care, and 18% in ACA Marketplace plans. Among the denials that were appealed, 67% were overturned in Medicare Advantage, 47% in Medicaid managed care, and 43% in the Marketplace. Many denials are about paperwork and process, not medical necessity, which is why they reverse so often.
How do you find out an authorization is required before the visit?
Build the check into scheduling, not billing. The cheapest authorization to get approved is the one you start before the patient shows up.
Create a short reference list of the services and payers that trigger authorization for your practice: advanced imaging, specialty procedures, infusions, DME, and certain referrals. Review it every quarter, since payers change requirements without much notice. Then make the front desk or scheduler responsible for flagging any order that matches the list.
In DrChrono, prior authorization alerts and the field for recording pending authorization numbers give you a place to track this inside the chart. Use them consistently. A tracked request that's missing a number is much easier to catch than one living in someone's notebook.
What documentation should go out with every request?
Incomplete submissions are the most common reason a request stalls or gets denied. Build a standard packet for each high-volume service so your staff isn't deciding what to attach every time.
A solid packet usually includes:
- The diagnosis codes and the specific procedure or drug codes being requested.
- Recent visit notes that document symptoms, duration, and functional impact.
- Records of conservative treatments already tried and their results.
- Relevant imaging or lab results.
- A short statement of medical necessity written to the payer's published criteria.
Payers publish their criteria, usually in a provider portal or a policy library. Match your language to the criteria's own wording. A reviewer scanning for "failed six weeks of physical therapy" shouldn't have to infer it from a note that says "patient not improving."
Which submission channel should you use?
Use the electronic path whenever the payer offers one. The 2019 CAQH Index estimated a manual prior authorization at roughly $11 versus about $2 fully electronic, and the faster channel also tends to produce a faster decision and a cleaner audit trail. Those figures are dated, but the gap between channels hasn't closed.
For prescriptions, DrChrono's CoverMyMeds integration handles the electronic route from inside the prescribing workflow. For medical-benefit services like imaging and procedures, expect to work through payer portals, with fax or phone as the fallback. Whatever channel you use, record the reference number and submission date immediately. That single habit prevents most "we never received it" disputes.
How should you track status and handle denials?
Set a follow-up cadence and stick to it. A common pattern is to check status at two business days, then every two to three business days until a decision lands. Put the next check date on the task so it doesn't depend on anyone's memory.
When a denial arrives, read the reason before doing anything else. Sort denials into three buckets:
- Administrative or missing information. Fix and resubmit quickly. These are the most common and the most reversible.
- Criteria not met on paper. Add the clinical evidence that was missing and request reconsideration.
- Genuine medical-necessity disagreement. Escalate to the provider for a peer-to-peer review or a formal appeal.
Because the KFF data shows so many appealed denials get overturned, it's worth appealing the ones that have a real clinical argument behind them. Appeals are also where documentation habits pay off, since a well-built packet from the first submission makes the appeal packet almost write itself.
Where does automation fit?
Everything above is repetitive, rule-driven work: checking requirements, assembling packets, submitting, and following up. That's the part software handles well, and it's the part that fills your staff's week.
An AI agent working alongside DrChrono can read the order and chart, pull the right documentation for the payer's criteria, submit through the correct channel, and check status on the schedule you set. Honey Health's prior authorization agent is built around that pattern. Your staff keeps the judgment calls, such as peer-to-peer reviews and clinical appeals, while the agent handles the volume.
Measure the result with two numbers: turnaround time from order to decision, and first-pass approval rate. If both improve over a quarter, the process is working. If they don't, look at where requests are stalling before adding more tools.
Frequently Asked Questions
What is the most common reason prior authorizations are denied?
Administrative and documentation problems are the leading cause: missing clinical notes, incomplete forms, wrong codes, or a request sent to the wrong channel. These denials are usually fixable and resubmittable, which is why they overturn so often on appeal.
How long should you wait before following up on a prior authorization?
Most practices check status after about two business days and then every two to three business days until a decision arrives. The exact cadence matters less than having a scheduled next-check date on every open request.
Does DrChrono track prior authorization status?
DrChrono offers prior authorization alerts and lets you record pending authorization numbers, and its CoverMyMeds integration tracks prescription requests. Medical-benefit requests submitted through payer portals generally need to be tracked by your staff or an automation tool.
Are prior authorization denials worth appealing?
Often, yes. KFF's 2025 payer-reported data shows a large share of appealed denials were overturned, including 67% in Medicare Advantage. Appeal the denials that have a clear clinical or documentation basis.
Can AI reduce prior authorization denials?
It can reduce the avoidable ones. An AI agent can check that a packet is complete against the payer's criteria before submission and keep follow-ups on schedule. It doesn't replace clinician judgment on cases that hinge on medical necessity.
