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Prior Authorization Workflow
Prior authorization processes are slow, opaque, and manual. Providers don't know where a request stands. Payers get incomplete submissions. Patients experience unnecessary care delays while paperwork travels by fax and email.
A physician orders a high-cost imaging study. Someone on the care team initiates a prior auth — but it requires clinical documentation, a physician attestation, and a payer review. Three departments are involved. The patient's appointment is in four days. Nobody knows if the authorization will come back in time, or if it came back at all.
Prior auth is a multi-party, multi-step workflow that most organizations still manage with phone calls, faxes, and spreadsheets. There's no system that holds everyone accountable to a timeline.
What's Actually Breaking
- Clinical documentation is collected informally — different people gather different information, and there's no standard for what a complete submission looks like.
- Approvals are multi-party but untracked — provider attestation and payer review happen in separate systems with no unified status.
- There's no patient visibility — patients often don't know their appointment is at risk until it's too late to reschedule.
How Pathways Handles It
A structured, multi-party approval workflow that keeps auth requests moving and every stakeholder informed.
Every workflow is configurable to your protocols, team structure, and EHR environment — no custom development required.
What changes when prior auth has structure, accountability, and real-time visibility.
More Workflows Like This
See how Pathways handles adjacent coordination challenges.
See Prior Authorization Workflow in Your Environment
We'll map your current auth process, identify where submissions stall, and show you exactly how Pathways would structure it.
Schedule a Workflow Assessment