40% Automation in Prior Auth? Here’s Exactly How We Did It
At iMagnum, we knew the solution wasn’t just more staff. It was smarter process design powered by intelligent automation. In just six months, we helped a group of urgent care and specialty clinics automate 40% of their prior auth volume using our proprietary engine: Prior Auth Smart. Here’s how we did it.
Step 1: Mapped the Entire Prior Auth Lifecycle
Before automating anything, we:
- Broke down every auth workflow from intake to approval
- Identified repeatable, high-volume request types (labs, imaging, DME)
- Logged payer behavior patterns and turnaround times
This clarity helped us isolate high-impact automation points.
Step 2: Integrated with PMS and EHR Systems
Instead of replacing the clinic’s system, we plugged into it:
- Extracted CPT/ICD data directly from encounters
- Pre-validated requests against payer policies
- Initiated auth requests through payer portals and APIs
This eliminated the need for double entry or platform switching.
Step 3: Built the Automation Layer with Prior Auth Smart
Our automation engine handled:
- Auto-generation of auth forms
- AI-driven matching to payer-specific submission rules
- Real-time tracking of auth status updates
- Auto-flagging denials for manual escalation
Tasks that took staff 15–20 minutes were completed in under 90 seconds.
Step 4: Staff Reassignment, Not Replacement
With 40% of auths handled automatically, staff were:
- Reassigned to complex cases and appeals
- Trained to manage exceptions and escalate denials faster
- Freed from routine data entry, improving morale and throughput
This human-AI balance kept the team engaged and elevated service quality.
The Measurable Outcomes
After 6 months of implementation:
- 40% of all auths fully automated
- 70% reduction in auth-related delays at front desk
- 120+ labor hours saved per month
- 2.4x faster payer response times due to accurate first submission
- Improved staff satisfaction with less burnout
Bonus: Predictive Flagging for Auth Risk
Prior Auth Smart also scores encounters by:
- Historical denial probability
- Payer behavior
- Timing against appointment window
This allows us to prioritize high-risk auths early, ensuring smoother scheduling and fewer cancellations.
Conclusion: Automation Where It Counts
You don’t need to automate 100% of prior auth to see big gains. By targeting the right 40%, we turned a painful process into a competitive edge.
At iMagnum, our goal isn’t just automation. It’s automation that works inside your reality—tech-agnostic, staff-friendly, and results-backed.
If prior auth is slowing you down, we already know how to speed it up.
