Prior Auth Turnaround Time: What It Is and Why It Matters

Prior Auth Turnaround Time is the elapsed time between submitting a complete prior authorization and receiving a decision, approval, denial, or a request for more information. Many payers start counting only when the packet is complete, so a technically submitted file that is missing notes or codes might not be in active review. In clinics that run on tight templates, that nuance determines whether a start of care proceeds smoothly or slips by a week.

Why it matters for access, throughput, and staff time

I have sat in plenty of back offices where the waiting is the work. Long turnaround times create idle slots, staff follow ups, and repeated calls that no one enjoys. The American Medical Association reports that many practices handle dozens of requests and spend close to two business days each week processing them, and eighty two percent of physicians say prior authorization can lead patients to abandon recommended treatment. The human impact is obvious, and so is the financial one, fewer visits, slower cash flow, and a tired staff.

The policy backdrop is shifting. CMS finalized time frames for impacted payers, seventy two hours for expedited requests and seven calendar days for standard requests. Even if a plan in your mix is outside scope, those numbers are useful guardrails for internal expectations and escalation points.

How it works, the bones of the process

Although every payer has quirks, the workflow follows a familiar arc.

1. Identify that prior authorization is required, ideally during benefits checks or scheduling. The goal is to avoid placing a patient on the calendar before confirming the rule set for that service.
2. Build a clean packet. That usually means demographics, eligibility details, diagnosis and procedure codes, and supporting clinical notes that explain medical necessity in a way a reviewer can follow.
3. Submit through the preferred channel, portal, electronic transaction, or fax. Log the time, the method, and any reference number. Those basics are your anchor during follow up.
4. Intake and acceptance into review. Treat submission and acceptance as separate milestones. If a payer flags the packet as incomplete, the clock has not truly started.
5. Clinical or administrative review, plus possible requests for more information. Response time on your side matters here, and it is a lever you fully control.
6. Determination received and routed to scheduling, clinical, and billing teams so downstream work can proceed without another day lost.

Steps you can adopt this week

• Define complete documentation for your top services, then save it where staff can actually find it. Pair those checklists with automated intake forms that collect required fields up front and reduce rework.
• Centralize communication, use a unified inbox so payer questions, patient updates, and internal notes do not scatter across email, portal messages, and voicemail.
• Track two timestamps for every request, submission time and acceptance into review. Add a lightweight tracker for time to complete intake, it often correlates with prior auth delays.
• Standardize your follow up rhythm, set day one confirmation checks, day three nudges, and a business day response target for requests for more information. Many clinics find that two way SMS improves response cycles without adding phone tag.
• Prefer electronic channels where available, and document when a payer requires fax so the team does not waste cycles retrying a portal that will never accept that service type.
• Keep your pre visit steps coherent. If you have not mapped them, start with this primer on pre visit workflows, and, if you offer remote visits, check your process for telehealth intake too.
• Confirm that your stack aligns with interoperability standards, cleaner data movement means fewer mismatches and fewer resubmissions.

Common pitfalls that slow the clock

Even seasoned teams hit the same snags repeatedly. Incomplete or mismatched codes, missing progress notes that articulate medical necessity, attachment formats that portals reject, and unclear internal ownership during vacations all add days. Splitting responsibility across too many hands adds more. Fragmented messaging adds the rest. When payer questions arrive through three channels, one of them will be missed. A brief note on positioning, Solum Health focuses on a solutions model built for outpatient facilities, a unified inbox with AI intake automation, specialty ready workflows, integration with EHR and PM systems, and measurable time savings. That is the direction many operations leaders are moving because it addresses the fragmentation that creates delay.

Brief FAQ, written for fast scanning

What is the average prior auth turnaround time?

There is no universal average. Timelines vary by payer, plan design, and service type. CMS requires impacted payers to send decisions within seventy two hours for expedited requests and seven calendar days for standard requests, which many practices use as planning benchmarks.

When does the clock start?

Most plans count from receipt of a complete packet. If documentation is missing, the request may sit outside formal review. Track both submission and acceptance so follow up aligns to reality, not hope.

What causes the longest delays?

Incomplete documentation, unclear medical necessity, manual channels, and slow responses to payer requests for more information. Workload on both sides contributes as well. The AMA’s research notes high volumes and significant weekly time devoted to prior authorizations.

Does turnaround time influence denials?

Yes. Care delivered before approval or care delivered after an authorization expires is more likely to be denied. Delays also correlate with patient drop off, which reduces completed courses of care.

What can we do in the next month?

Standardize checklists, consolidate messaging in a unified inbox, and automate intake where you can. Review a sample of recent cases, find where days were lost, and fix that specific handoff.

Action plan, concise and realistic

Start by naming an owner for prior auth operations, then give them a weekly dashboard that lists submissions, acceptance timestamps, pending requests for information, and determinations. Adopt a simple rule, no request sits without a status check for more than two business days, and no request waits more than one business day for your response. Move common tasks into patient portal software and automated intake forms so fewer details are lost in translation. If you need a broader foundation, browse Solum’s glossary for adjacent concepts you can standardize next, for example telehealth intake and pre visit workflows.

For policy and workload context, see the CMS fact sheet that outlines decision time frames in plain language, CMS Interoperability and Prior Authorization Final Rule, and the AMA’s summary of burden and abandonment rates, Advocacy in action, fixing prior authorization.

If you remember only one idea, make the invisible visible. Treat Prior Auth Turnaround Time as a metric you can influence, not as a fate you must accept. Small, steady gains across documentation, messaging, and response time add up. They also return something scarce to your team, time for patients and time to think.