Tearing Down the Barrier of Prior Authorization Through Automation

If you’ve ever had to chase down a prior authorization before getting your medical procedure approved for coverage, you’re not alone. According to a recent white paper by the American Hospital Association, prior authorization has been found to be a barrier to care, restricting access to coverage for many patients. Paul Shorrosh, founder and CEO of AccuReg is here to change that. Shorrosh sits down with host Kevin Stevenson to talk about the importance of pushing for change and adapting prior authorization automation.

According to Shorrosh, automating prior authorization helps hospitals and health systems integrate patient engagement, intake, and access to enable increased revenue. However, insurers have generally refused to automate. Instead, insurers have stayed old school, “So what they use is fax machines, phone calls, emails, and web portals,” said Shorrosh.

Prior authorization not only prevents patient care but often results in unpaid bills and coverage denials, “So nothing good comes out of that process especially when a lot of those procedures could be approved by the payer in advance if it were an easier, more automated modern process,” stated Shorrosh.

Given there is an existing industry standard, the 278 standard, for electronic authorization, widespread automation should not be an issue. However, Shorrosh said insurers are not being “held accountable to use it.”

Shorrosh’s solution is to use a best practice approach involving five steps, in order:

  1. Identity and demographic validation
  2. Eligibility and benefit verification
  3. Prior authorization requirement check
  4. Submission management platform; submit request to payer
  5. Retrieving authorization and status

Shorrosh said, “We’re not even asking the payers to reduce their requirements,” but pushing for change in an industry that is slow to adapt.

To encourage this, Shorrosh said, “I hope that CMS and government entities will help with that, make this electronic.”

Automating the prior authorization process not only improves speed of acceptance, but ultimately helps the patient.

More Like This Story:

Best-Selling Author Uses Art To To Teach Interpersonal Development

How To Navigate the American Healthcare System

Follow us on social media for the latest updates in B2B!

Image

Latest

Burl Stamp
Improving Employee Engagement Through CAREmunication — A Conversation with Burl Stamp
August 21, 2025

With the healthcare landscape seeing many evolving changes, employee engagement is no longer just a buzzword — it’s now a business imperative. Amid rising turnover and persistent staffing shortages, organizations are under pressure to build resilient, engaged teams. According to Gallup, 70% of the variance in team engagement is tied to one factor: the…

Read More
precision machining
Pharma Manufacturing: Meeting Annex I with Precision Machining for Safer Sterile Drug Production
August 21, 2025

Pharmaceutical manufacturers are under increasing pressure to deliver sterile, high-quality medicines in smaller batches and faster cycles. As pharma manufacturing evolves, regulatory demands have intensified, especially following the 2023 revision of EU GMP Annex I, which places new emphasis on contamination control strategies, improved traceability, and minimizing human intervention throughout production. According to American…

Read More
peer guidance
Leaders Who’ve Been There: Finding Clarity Through Peer Guidance at Purpose Factory
August 20, 2025

Running a business can feel isolating without peers who understand the weight of leadership. Madison Harris, founder of Cobalt Fund Services, found the peer guidance he needed through Purpose Factory. He gained strategic insight and real feedback from seasoned entrepreneurs at a time when his business needed clarity and structure. Harris realized Cobalt wasn’t…

Read More
business acumen
Expanded Business Acumen: How Peer Feedback at Purpose Factory Fueled Smarter Leadership
August 20, 2025

Entrepreneurs often take on too much, attempting to manage every aspect of their business. For Jeremy Scott, Owner of Summit Cove Realty, Purpose Factory offered the structure and peer accountability needed to delegate, refocus, and expand his business acumen. After juggling responsibilities in sales, investments, retail, and utilities, feedback from fellow members led him…

Read More