Reviewing Prior Authorization Timeliness

Key takeaways

Prior authorization timing is interpretable only when the request event, payer response, and expiration are defined. The review describes the sampled records and does not claim a universal benchmark.

Research context

A method for measuring request, response, and expiration.

Review method

Define the population from a fixed export and record the query date, filters, source, and exclusions. Apply a short checklist and test it on a calibration sample. Separate preparation from judgment: the reviewer classifies and routes; the authorized owner decides.

Limitations

The review describes the sampled records, not the whole population. A closed status is not proof of resolution. Report denominators and assign corrective actions an owner and retest date.

Practical use

Use one bounded review to improve a workflow, then retest.