Prior Auth Reconsideration: What It Is and How It Works

Prior auth reconsideration is a formal request that asks a payer to review a denied prior authorization again after you submit corrected or additional information. It usually happens soon after a denial and before the denial becomes final. Think of it as a focused second look, one that exists to fix missing documents, coding mismatches, or unclear medical necessity. It is not an appeal. It is faster and less formal, and it is meant to resolve cleanly fixable issues.

If you want more background on the broader workflow, see related entries in the Solum Health resource library. You can read the overview of Advanced Prior Authorization, how an Authorization Queue functions, when Automated Denial Appeal is appropriate, why Automated Eligibility Check and Benefit Verification matter, and how Automating Pre Visit Workflows helps teams stay ahead of payer requests. The full Glossary is updated regularly.

For context and data, the national physician survey from the American Medical Association details how prior authorization drives delays and added administrative work. See the AMA summary here, prior authorization survey findings. For a definition set by a federal authority, see the Centers for Medicare and Medicaid Services page on reconsideration mechanics, reconsideration guidance.

Why this matters for access, throughput, and staff workload

Access, because a quick and well supported reconsideration prevents cancellations and keeps the plan of care on track.

Throughput, because faster resolution protects weekly visit capacity and reduces reschedules.

Staff workload, because a tight reconsideration package avoids a full appeal cycle, which burns hours on letters and phone time.

In short, when you work reconsiderations with discipline, you recover momentum. When you do not, you accept longer timelines and more rework.

How reconsideration works in practice

The structure is consistent across payers even if forms differ. You correct the record, you ask for a second review, and you track the response. That simplicity is the point. I advise teams to avoid long narratives and focus on the items that address the denial reason.

• Review the denial reason. Read it closely. Identify the exact cause, for example missing documentation, an incorrect code, an eligibility issue, or an unclear statement of medical necessity.
• Identify what needs to change. Decide what must be added or corrected. That may include updated clinical notes, clearer justification, corrected codes, or a complete form.
• Prepare the reconsideration request. State that it is a reconsideration, list what you have added or corrected, and connect each item to the original denial reason. Keep it precise.
• Submit and monitor the request. Use the payer portal, fax, or secure messaging as required. Track the submission date, set a follow up, and escalate if the timeline slips.
• Respond to the outcome. If approved, proceed with scheduling and care. If denied again, decide whether to move to an appeal and leverage the material gathered in this step.

If you want a high level tour of Solum’s operational approach, you can review How it works and the Solutions overview. Solum positions itself as a unified inbox and AI intake automation for outpatient facilities, specialty ready and integrated with EHR and PM systems, with measurable time savings.

Steps to adopt this week

• Create a standard checklist that mirrors the most common denial reasons you see. Place it in your intake and billing workspace.
• Set a daily triage time for new denials, even 15 minutes. Assign a single owner who routes each denial to a named person to draft the reconsideration.
• Use a single template for the request cover page. State that you are submitting a reconsideration, cite the denial reason, list the new documents, then add two or three sentences that connect those documents to the payer requirement.
• Track every submission and due date on a visible list that your team reviews twice per week. If your tools support it, tie follow ups to your task system, and surface reminders at scheduling.
• Measure results for one quarter. Count resolved reconsiderations, average days to response, and the number that had to escalate to appeal. Use those numbers to tune the checklist.

Pitfalls to avoid

• Rewriting the story instead of correcting the facts. Reconsideration is not a policy debate, it is a short fix.
• Submitting without new information. If nothing changes, the outcome rarely changes.
• Letting requests sit without follow up. Many denials age because nobody owns the clock.
• Burying the dates and visit limits in scanned documents. If schedulers cannot see the limits, you will repeat denials.
• Working from personal inboxes. Shared visibility prevents time lost to duplication.

Quick FAQ

• What is the goal of prior auth reconsiderationThe goal is to reverse a denial by supplying corrected or additional information before the denial becomes final. This allows a payer to reassess without a full appeal.
• How long does prior auth reconsideration takeTimeframes vary by payer, however reconsideration is typically faster than appeal. Many teams see responses within several business days, and timelines improve when follow up is clear.
• Is reconsideration required before an appealNot always, yet it is often recommended. Skipping it adds time and effort during the appeals process and reduces the chance of a quick resolution.
• Who submits the reconsideration requestAuthorization, billing, or front office teams usually submit the request, and clinicians often contribute notes that clarify medical necessity.
• What happens if reconsideration is deniedYou can escalate to a formal appeal. The documents assembled for reconsideration often strengthen that submission.

Action plan

Define your checklist and owner, adopt a single cover page template, and set two weekly checkpoints for status and follow up. Add visibility at scheduling so staff see dates and limits before they book. Track results for one quarter and adjust. If your practice is moving toward integrated operations, consider whether a unified inbox and AI intake automation, specialty ready and connected to your EHR and PM systems, would reduce rework and improve response times. The intent is simple, fix what you can quickly, move what you must to appeal, and spend the saved time on patients rather than paperwork.