Prior authorizations in private clinics: where revenue is lost
In a private clinic, prior authorization is not just paperwork: it is a revenue-control point. Loss appears when a request is late, submitted with incomplete documentation, approved but expired before the appointment, or billed without the right authorization number. The clinic should measure volume by insurer, denials, expiries, resubmissions and approved-but-unbilled authorizations before automating.
Prior authorization is a revenue process, not only admin
In many clinics, authorizations live at reception: calls, PDFs, portals, reminders and spreadsheets. But the final impact is managerial: services performed but not paid, delayed tests, cancellations and rejected invoices.
Calculate revenue lost to authorisations
Use the SaludComply authorisation diagnostic to estimate monthly loss, recoverable range and operational complexity. No patient data required.
The five points where the process breaks
The process breaks on small details: a late request, a clinical note that does not justify the act, a wrong code, an unchecked portal status or an authorization that expires before the appointment.
What a clinic should measure every week
Measure volume by insurer, denial rate, expiry rate, resubmissions, average time to approval and approved authorizations pending billing. A clean four-week table often reveals the real problem size.
When does automation make sense?
It makes sense when a clinic has more than roughly 200 authorizations per month, works with three or more insurer portals, or has at least one part-time person chasing statuses and expiries.