Can Better Information Make Prior Authorization Faster?
Research from a radiation oncology practice suggests that earlier access to payer requirements could improve authorization outcomes.
A study published in JAMA Network Open in December 2025 reported a 65.4% relative reduction in initial authorization denials and a 33.9% decrease in median authorization time after a radiation oncology practice introduced software-supported prior authorization.
Those findings are particularly interesting because the intervention did more than move requests electronically. It brought payer-specific requirements and relevant clinical information together earlier in the authorization process.
Prior authorization often requires clinical teams to establish why a proposed treatment meets an insurer's criteria. Providers may know exactly why the treatment is appropriate without knowing which details a particular payer expects to see. Authorization staff must then connect those requirements to the available documentation, identify missing information, and coordinate any necessary follow-up.
If those gaps aren't identified until after submission, the process can circle back for records, clarification, or corrections before a decision is made.
The study explored whether addressing those needs earlier could change the outcome.
The Study and Its Results
Researchers examined 6,551 radiation oncology cases within Northwell Health, comparing 2,403 cases processed using an integrated authorization system with 4,148 historical control cases.
| Measure | Historical workflow | Software-supported workflow |
|---|---|---|
| Cases evaluated | 4,148 | 2,403 |
| Initial authorization denials | 7.6% | 2.6% |
| Median authorization time | 4.2 business days | 2.8 business days |
The reduction in initial denials represented a reported 65.4% relative decrease. Median authorization time fell by approximately 1.4 business days, a 33.9% reduction.
Authorization time was measured from creation of the treatment prescription to recorded payer authorization. The measurement therefore covered more than the time needed to prepare or transmit a request.
Results varied among payers, with some showing larger improvements than others.
The intervention didn't eliminate denials or waiting periods. However, it was associated with fewer initial denials and faster authorization decisions in the population studied.
What Changed in the Workflow?
The software evaluated in the study, InsightRT, integrated authorization support into the clinical workflow.
When a treatment order was identified, it could initiate authorization activity, recognize the payer, retrieve relevant clinical details, and compare available information against payer-specific requirements.
Missing documentation or discrepancies could then be flagged for staff to address before submission.
Radiation oncology provides a useful setting for examining this approach. Treatment requests can involve specialized procedures, complex clinical records, and medical necessity criteria that differ among payers.
A request might require information about diagnosis, cancer stage, prior treatments, or the proposed radiation technique. When an expected detail is absent, an integrated system may make that gap visible while the clinical team is preparing the request.
The technology was rules-based rather than artificial intelligence. Its assessments relied on available payer policies and defined documentation requirements. It did not independently recommend treatments or replace physician judgment.
The distinction is important. The intervention wasn't designed to select care on behalf of clinicians. It was designed to help them understand what information an insurer required for the care already selected.
An Electronic Request Can Still Be Incomplete
Electronic submission alone doesn't guarantee an efficient authorization process.
A request can be transmitted successfully while still lacking information needed for medical necessity review. Staff may then have to locate additional documentation, contact clinicians, or clarify the request after the payer identifies a deficiency.
The integrated system attempted to shift some of that work to an earlier stage.
Staff still needed to review information and resolve discrepancies. Payers still evaluated requests under their applicable criteria. The software didn't guarantee approval or eliminate differences in payer interpretation.
What changed was the opportunity to recognize certain documentation requirements before the request entered the usual review process.
That distinction helps explain the reported improvement without treating automation as a complete solution to prior authorization.
The Experience of Physicians and Billing Staff
The researchers also surveyed staff who used the software.
Fifteen participants completed the survey, including seven physicians and eight billing employees. Responses generally reflected improved satisfaction with speed, transparency, ease of use, and the overall authorization experience.
Physicians reported particularly positive experiences, while billing employees also described improvements.
The survey offers a useful perspective alongside the operational results, although the small number of respondents limits how broadly their experiences can be interpreted.
Implementation, training, payer participation, and the fit between technology and existing responsibilities can all influence whether staff experience similar improvements elsewhere.
How Far Can These Findings Travel?
The study involved a single academic health system's radiation oncology practice. Although multiple locations and health plans were represented, the results cannot automatically be applied to every specialty or healthcare organization.
Researchers also compared the intervention group with historical controls rather than using a randomized trial. That design identifies associations but doesn't definitively establish that the software alone caused every improvement.
Organizations with different staffing, technology, and payer relationships may encounter different implementation challenges or outcomes.
The researchers also acknowledged a concern surrounding automated authorization tools: payer requirements might influence prescribing choices when those requirements don't align with clinical evidence.
InsightRT was designed to display requirements for the treatment selected by the physician, rather than recommend a different treatment. The study did not find a statistically significant change in the proportion of treatment modalities prescribed after implementation, although that finding doesn't eliminate the broader concern.
Nor does better documentation resolve every disagreement about medical necessity. Some authorization disputes concern the underlying coverage policy rather than missing records.
These boundaries are important when interpreting the results.
Looking Earlier in the Process
Prior authorization discussions frequently focus on the time spent waiting for decisions, particularly when delays affect scheduling, treatment, and patient access.
This research points toward another part of the process: the information available before a request is submitted.
The reported improvements suggest that earlier access to payer requirements can make a difference in a complex clinical setting, even while the authorization requirement itself remains in place.
Whether similar outcomes can be reproduced across other specialties and organizations will depend on further research, implementation, and payer participation.
Prior authorization isn't disappearing. But the possibility of spending less time waiting for information, correcting avoidable problems, and resubmitting requests is becoming easier to imagine.
References & Further Learning
Chen, W. C., Carpenter, C., Sidiqi, B., et al. (2025, December 22). Integrating Prior Authorization Into Clinical Workflows for Care Access and Practitioner Experience. JAMA Network Open, 8(12), e2549093.
https://doi.org/10.1001/jamanetworkopen.2025.49093
Full study: https://pmc.ncbi.nlm.nih.gov/articles/PMC12723545/
Educational Disclaimer
Revenue Cycle Uncovered is an independent educational resource. Content is provided for general informational purposes and does not represent the policies, practices, or positions of any employer or organization. Workflows, payer requirements, regulations, and operational practices may vary. Information should be independently verified when applied to specific situations.