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

summer melt
From Freshmen to Founders: Michigan Students Take on Higher Ed’s Summer Melt Crisis with MeetYourClass
May 29, 2025

A growing number of colleges are struggling to convert applicants into enrolled students—and to keep them engaged through graduation. With Gen Z students relying heavily on familiar digital platforms like Instagram and Discord for social interaction, traditional college tools for orientation, enrollment, and community-building often miss the mark. According to research, between 10 to 40…

Read More
Aviation maintenance
The Future of Flight Depends on Mechanics, Not Machines: How Jets MRO is Solving the Aviation Maintenance Talent Gap
May 28, 2025

Private aviation is booming—but behind the sleek jets and luxury cabins lies a hidden crisis. A looming shortage of qualified aviation maintenance technicians threatens to ground growth. According to Boeing’s 2023 Pilot and Technician Outlook, the industry will need about 690,000 new maintenance technicians by 2042. While private jet usage is skyrocketing, the infrastructure to…

Read More
digital learning ecosystem
Stride at 25: Redefining the Digital Learning Ecosystem for Today’s K–12 Learners
May 28, 2025

As virtual learning matures and school choice accelerates across the U.S.,the 25th anniversary of Stride Inc. offers a moment to reflect on how far the digital learning ecosystem has come and where it’s headed.. Once known as K12 Inc., the company helped pioneer online education at scale. But in a landscape shaped by evolving…

Read More
search
From Search (SEO) to Answers with Generative AI
May 27, 2025

In this episode of The Marketing AI SparkCast, Aby Varma—founder of Spark Novus, which partners with marketing leaders to adopt AI responsibly and strategically—hosts Mike Ensing, Founder and CEO of Revere AI. They explore how LLMs are revolutionizing search, shifting the customer journey, and forcing a new marketing playbook where brand discovery is increasingly…

Read More