Why small practices lose authorizations

Prior authorization tracking in a small practice usually fails for an ordinary reason: the work lives in people. One person remembers the pending request, another has the approval letter in a fax pile, and the scheduler books the visit without knowing either. Nothing looks wrong until one of them takes a week off.

The fix is not software. It is one list that holds every request, one person who owns it and a habit of looking at it on a schedule.

One list, one owner

Put every request in a single place: a worklist in your record or practice management system, or a shared spreadsheet. The list holds patient information, so keep it only in a system your practice has approved for that purpose, with access limited to staff who need it.

Name one owner and one backup. The owner need not do every task, but knows whether the list is current. The backup opens it at least weekly, so covering an absence is routine.

The columns that matter

These columns are enough:

  • Patient name and record number
  • Payer, plan and member ID
  • What was ordered, by which clinician, and the planned date of service
  • Whether authorization is required, and how you confirmed it
  • Date submitted and method (portal, fax or phone)
  • Payer reference number
  • Status
  • Approved units or visits, start and end dates, and the authorization number
  • Next action, who owns it and the date it is due

The last line makes the list work. Every open request needs a next action with a name and a date. A row without one is a request nobody is working.

A status vocabulary everyone uses

Agree on a short set of statuses and do not improvise: to be checked, not required, submitted, more information requested, approved, denied, in appeal, expired and closed.

Avoid a bare “pending”. A request waiting on the payer and one waiting on your own chart note look identical under that word, and only one of them is in your hands.

A daily and weekly routine

The schedule matters more than the tool.

  1. Daily: add new orders, confirm whether each needs authorization, submit what is ready and record any decisions that arrived.
  2. Daily: work every row whose next action is due.
  3. Weekly: check each open request with the payer and log the contact.
  4. Weekly: review approvals that will expire or run out of units in the coming weeks.
  5. Before booking: look up the patient before scheduling any service that needs authorization.

The fifth step depends on the front desk, so share the list with whoever handles scheduling and referral records.

Know which services need authorization

Requirements differ by payer and plan, and they change. Build your own reference as you go. Each time you confirm a requirement, add a line with the payer, the service, the date and where the rule is published. Recheck it whenever a payer sends a policy notice.

When a payer says no authorization is needed, record the date, the representative’s name and the call reference number, in case the claim is questioned later.

Most stalled requests are waiting on something from the chart. Good documentation habits shorten that wait, because the note the payer asks for already exists.

Expirations and units

An approval covers a set number of visits or units inside a date range. Ongoing care, such as a course of wound treatments, can run past either limit unnoticed. Track both, and count units down as visits occur.

Flag each approval ahead of its end date, with lead time for the clinician to decide whether to request more. Give the authorization number to billing as soon as it arrives. An approval is not a promise of payment, so when a claim denies anyway, send it to claims follow-up with the row attached.

Patients who ask why they are waiting can be given our plain-language guide to prior authorization for wound care.

When to get help

Building the list is the easy part. Keeping it current through busy weeks is harder. If rows go stale, approvals lapse or the owner is also your only biller, consider sharing the work.

Gateway offers prior authorization tracking for practices in Greater St. Louis and the Metro East. Higher-volume practices can ask about AI-assisted authorization workflows, with staff reviewing everything before it goes out. Clinical content and medical necessity stay with your clinicians. Reach us through the practice support inquiry form or at 314-325-0126.

Common questions

Is a spreadsheet good enough for tracking prior authorizations?

Often yes, provided it is kept in a system approved for patient information and opened every day. Its weakness is that it reminds no one of anything, so sort by next-action date each morning. Move to a worklist inside your record system when volume makes that a chore.

Who in a small office should own prior authorizations?

Someone who is at a desk most of the day, can find the right note in a chart and is comfortable on the phone with payers. Often that is a medical assistant, a referral coordinator or the biller. It should not be the clinician, who still answers clinical questions and handles peer-to-peer calls.

How often should we follow up on a pending request?

Set a fixed cycle, such as weekly, and tighten it for requests tied to a scheduled date of service. Many payers publish expected turnaround times. Write the expected response date on the row and follow up the day after it passes, instead of waiting for the patient to call.

How do we tell whether the tracking system is working?

Watch three things each month: services rescheduled for lack of an approval, claims denied for a missing or expired authorization, and open rows with no next action. If all three are falling or near zero, the system works. If denials continue, look at where the row broke down, not at whom to blame.

Related pages

Updated October 2026