Reducing Delays, Strengthening Compliance, Protecting Revenue
In 2025, prior authorization has become one of the most complex and time-sensitive components of the revenue cycle. Hospitals, physicians, and clinics are now required to meet tighter submission timelines, new electronic-exchange mandates, and rapidly shifting payer criteria.
At IntegraRCM, we manage the entire authorization process from verification to approval, ensuring that care proceeds without administrative interruption and that reimbursement remains secure.
The 2025 RCM Blueprint identifies prior authorization as the single largest source of front-end denials. Roughly one in four claim rejections stems from missing or expired authorizations, and 93% of physicians report patient-care delays as a result.
New federal rules, particularly CMS-0057-F, now require payers to respond to urgent requests within 72 hours and standard ones within seven days, with all activity shifting to electronic APIs by 2027.
Authorization accuracy is no longer just a compliance task; it is a determinant of cash-flow stability.
Verification
Documentation
Submission
Tracking
Approval
Integration / Appeal
A closed-loop authorization cycle ensuring precision, speed, and compliance.
| Area | Before IntegraRCM | After IntegraRCM |
|---|---|---|
| Turnaround Time | 3–5 days, variable by payer | 1–2 days average |
| Authorization-Related Denials | 10–15% of total denials | < 5% within first 90 days |
| Staff Utilization | Clinical/front-desk staff on calls and portals | Administrative load centralized |
| Scheduling Impact | Frequent postponements | Reliable scheduling with verified approvals |
| Audit Readiness | Manual logs and incomplete documentation | Fully auditable digital trail |
0%
Surgeon throughput gain
0%
Authorization-related denials
0%
Approval rate achieved
| Model | Description | Best Fit |
|---|---|---|
| Per-Case Fee | Fixed rate per completed authorization (includes submission and follow-up) | Low-volume clinics |
| Dedicated FTE Model | Full-time specialists working exclusively on your authorizations | Hospitals & multi-site groups |
| Hybrid Engagement | Retainer + per-case billing for overflow | Medium-sized practices |
Each engagement begins with a 30-day onboarding period covering payer matrix setup, template design, and baseline metric reporting.
Within three months of implementation, clients typically observe measurable revenue stabilization and reduced scheduling disruption.
High-cost imaging, outpatient surgeries, specialty drugs, and durable medical equipment most often require payer authorization.
Yes. We interface with common platforms and maintain secure HIPAA-compliant data exchange protocols.
Urgent cases are flagged for same-day submission and direct payer contact, meeting the new 72-hour CMS response window.
Yes. Denied authorizations are reviewed, corrected, and resubmitted with supporting documentation until resolved.
All processes adhere to CMS-0057-F and payer-specific regulations. Every authorization is traceable with time-stamped audit logs.
Absolutely. Our model supports full outsourcing or co-managed arrangements where internal staff handle verification while IntegraRCM manages submissions and tracking.
We'll review your current authorization turnaround, denials, and policy adherence, then deliver actionable recommendations to streamline your process.
Audit reports are delivered within 10 business days.