How Orbit Is Modernizing Prior Authorization Process Automation In Healthcare

prior authorization

Prior authorization (PA) in healthcare requires providers to request approval from insurance payers before delivering services, but it often leads to significant delays in patient care. The traditional manual method involves checking insurance details, submitting requests, and following up, which can be time-consuming—often requiring lengthy phone calls and extensive documentation if a request is denied.

In contrast, automated PA systems streamline this process by efficiently retrieving patient data, validating information, and preparing requests. This automation not only updates medical records but also tracks the status of requests, reducing the burden on providers.

The challenges of manual PA have serious implications. Providers face rising costs, with 35% hiring additional staff to manage these requests, and the average cost per manual authorization is $11, taking about 20 minutes. Physicians report high administrative burdens, with 93% stating that PA contributes significantly to their workload. For patients, the consequences can be dire: delays in care can lead to increased hospitalization risks, life-threatening events, or even permanent damage.

Orbit’s AI-powered prior authorization process automation addresses these issues, offering significant cost savings—approximately 60% per authorization and $449 million overall in the U.S. healthcare system. Benefits include a streamlined workflow that saves provider groups up to 24 hours daily, reduces processing time to just five minutes per request, and minimizes human error. The automated system also decreases turnaround times by 55%, allowing staff to save nearly 12 hours weekly. By enhancing efficiency and accuracy, Orbit’s solution not only improves patient experience but also alleviates the administrative burden on providers.

Prior Authorization Automation
Source: Orbit Healthcare