JRW / Medical / Prior authorization case study
Denials nearly halved, and three hours a day back on prior authorization.
Gastroenterology practice · Northeast · 9 providers · 3 locations
Staff were filling payer forms by hand and waiting on hold. JRW’s agent now works the day’s authorizations from the chart in the practice’s EHR, submits each one on the payer’s own channel, and writes the approval back to the order.
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3 hrs
saved per coordinator, every day.
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9%
of requests denied first time, down from 17%.
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4 → 1
days from order to submission.
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7,500
authorizations a year, across 15 payers.
Prior authorization was a full-time job nobody was hired for.
The AMA’s 2025 survey counts 40 prior authorizations per physician each week, prescriptions included, and 13 hours of physician and staff time; our prior authorization calculator starts from those figures. More national figures are in our prior authorization statistics. Endoscopy and IBD biologics put a gastroenterology practice at the heavy end of that.
The practice files about 7,500 a year across 15 payers. Three coordinators filled each payer’s form by hand and saved up requests to get through several in one phone call. Requests went in four days after the order, about one in six was denied first time, and procedures were rescheduled while the paperwork caught up. Pending requests were chased when someone remembered, and denials were rarely appealed.
What happens to an order.
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001
Checks what needs one
The agent checks each new order in the EHR by payer, procedure, place of service and diagnosis, and puts the ones that need an authorization on the worklist with the right channel.
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002
Reads the chart in the EHR
The agent answers the payer’s questions from the chart, and every answer points to the chart entry it came from. It leaves anything the chart doesn’t support blank for staff. Nothing is exported or re-keyed, and nothing goes to a payer until a coordinator approves it.
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003
Submits on the payer’s channel
The agent submits electronically where the payer accepts it, or by fax on the payer’s own form with a clinical summary attached.
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004
Makes the phone call
A voice agent makes one call per payer covering every patient on the list. It says it is automated, and records an approval only when the number is in the transcript.
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005
Chases it to a decision
The agent checks pending requests every day on the payer’s portal or by phone. For a denial, it records the payer’s reason and drafts an appeal for a coordinator to send.
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006
Writes it back to the EHR
The agent writes the status, authorization number and dates onto the order, and files the packet, the payer’s letter and the call transcript in the chart.
The wins.
- Three hours a day back for each coordinator, most of it because the agent fills the forms and makes the payer calls.
- First-time denials down from 17% to 9%, because the agent sends the evidence the payer asks for the first time. Our guide sets out how to cut prior authorization denials.
- Requests go in the day after the order, down from four days, so fewer procedures are rescheduled.
- Biologic renewals start two weeks before an authorization runs out, not the week after.
- One phone call per payer, not one per patient.
- Every denial gets an appeal drafted the same day. Before, few were appealed.
- The agent reads from and writes to the practice’s existing EHR. Nobody re-keys anything, and adding a payer is a settings change.
Built for regulated work.
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A person approves
A coordinator approves every submission, fax and call first.
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Every answer cited
Each answer on a payer form points to its source in the chart.
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Every step logged
The agent records each step and everything it sends to a payer, for the practice to audit.
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BAA first
We signed a BAA with the practice before the build started.
Tell us how many authorizations you file a week.
A 30-minute call with Jeff. You’ll leave knowing whether it’s worth automating and how we’d connect to your EHR. Each automation is quoted as one fixed price, and if the first misses the scope we agree, you don’t pay for it.
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