p>A reauthorization workflow protects continuity of care, keeps visits on the books, and spares teams from last minute scrambles. Volume is not theoretical. Medicare Advantage plans processed nearly fifty three million prior authorization determinations in 2024, a scale that telegraphs how easily clinics get caught in delays. See the Kaiser Family Foundation analysis here, Medicare Advantage insurers made nearly 53 million prior authorization determinations in 2024. The burden is not just administrative. In a national physician survey, more than nine in ten clinicians reported that prior authorization delays access to necessary care, and a large majority reported negative effects on outcomes and burnout. See the American Medical Association summary here, AMA survey indicates prior authorization wreaks havoc on patient care.
A reauthorization workflow is the repeatable, end to end process a clinic uses to renew insurance approval for ongoing services when an existing authorization is approaching its visit limit or expiration date. In therapy settings, the requirement is common. Payers want updated progress notes, clear evidence of medical necessity, and specific plan details before they will allow care to continue. The workflow exists to make that renewal predictable and timely.
If you are building or refining this for your team, anchor it to a reliable operations backbone. A platform that centralizes unified inbox work, that offers intake automation, and that connects to EHR and PM systems, reduces the handoffs that cause reauthorization to slip. Solum Health positions itself for outpatient facilities with patient communications and intake captured in one place, specialty ready workflows, and measurable time savings. Use that as a mental model for the kind of infrastructure that helps the workflow hold up on busy days, even if your stack looks different.
You can implement the sequence below without changing your clinical model. The emphasis is on clarity, ownership, and cadence.
Record start date, end date, visit limit, visits used, services authorized, and any special payer notes. Treat this as your single source of truth. If the data is wrong, every downstream step becomes fragile.
Trigger preparation early enough to absorb payer response times. Common internal rules are thirty days before the end date, or when four to six visits remain, whichever comes first. The goal is to avoid the cliff.
Requirements vary by payer, plan, and service type. Build a living checklist that covers updated treatment plan, progress notes for the defined period, outcome measures when relevant, credentials, and signatures. Revise the checklist when you encounter recurring issues, and retire guesswork.
Name the owner for documentation readiness. Define what complete means, and the due date relative to your runway. The standard should balance specificity and parsimony, enough detail for medical necessity, no padding that invites confusion.
Use the payer’s preferred channel and add a short submission check. Verify codes, date ranges, attachments, and alignment between narrative and plan. Aim for first pass success, not hurry.
Log submitted date, any acknowledgments, requests for more information, determination, and the next action with an owner. Check status on a predictable rhythm, for example every three to five business days, and escalate before the last authorized visit approaches.
Once approved, update the record and confirm that scheduling and billing reflect the new parameters. If denied, document the reason, route to the right owner, and take the next step your policy allows, correction, resubmission, peer to peer, or appeal.
Confirm whether care can continue as scheduled. If adjustments are necessary, set expectations plainly. Avoid jargon, stick to dates and next steps.
Prior authorization is approval to begin a service. Reauthorization is approval to continue that service after the initial authorization expires or the visit limit is reached. Both require documentation of medical necessity.
It depends on the payer and service type. Some authorizations expire after a fixed period, others after a set number of visits. Track both, then start preparation early enough to avoid interruptions.
Visits may need to pause or move at financial risk. Many payers deny claims for services delivered without an active authorization. That creates write offs, rescheduling, and patient frustration.
Responsibility varies by practice. The most reliable approach names owners for tracking, documentation readiness, submission, and follow up, with clinical staff providing the medical necessity content.
Start earlier, centralize tracking, standardize documentation, and use a predictable follow up cadence. Update scheduling and billing immediately after decisions. Small process improvements compound.
This is a practical process, not a silver bullet. Build it, run it, and refine it. The reward is a calmer front office, steadier schedules, and fewer days when an expired authorization hijacks the afternoon.
