--- title: "Prior auth performance beyond approval rate - Davner" description: "Approval rate shows whether care can proceed. Turnaround time, rework, and staff effort reveal how well the authorization process works." canonical_url: "https://davner.com/blog/prior-auth-performance-beyond-approval-rate" type: "article" published_at: "2026-08-20" updated_at: "2026-08-20" --- Source: https://davner.com/blog/prior-auth-performance-beyond-approval-rate [Blog](https://davner.com/blog) # Prior auth performance beyond approval rate Approval rate shows whether care can proceed. Turnaround time, rework, and staff effort reveal how well the authorization process works. Benjamin Lee, PhD — August 20, 2026 ![Small red documents beside a larger red document.](https://davner.com/marketing/blog/prior-auth-performance-beyond-approval-rate.fallback.png) Approval rate is one of the most important prior authorization metrics. Of all the things a provider wants to do for their patients, how many actually get approved? But approval rate only tells you the final result. It doesn't tell you how much work it took to get there. A prior authorization that gets approved on the first submission and a prior authorization that gets approved after an additional information request, denial, appeal, and peer-to-peer both look the same in the final approval rate. One required almost no additional work. The other may have taken weeks, pulled several staff members away from their jobs, and required the physician to get on the phone. Practices should keep track of whether they're getting authorizations approved. They should also keep track of what happens underneath the hood. ## Start with the first-pass approval rate The first metric to put next to the overall approval rate is the first-pass approval rate. That's the percentage of authorizations approved without a denial, appeal, additional information request, peer-to-peer, or any of the other steps that slow the process down. First-pass approval rate gives you a rough measure of how much rework is going into the process. It can reflect a variety of things: - The quality and completeness of the clinical documentation - Staff comprehension of medical coding and procedures - Whether the right payer or medical benefits manager received the request - Whether the submission included what the payer actually requires A high overall approval rate with a lower first-pass approval rate means the practice is ultimately getting care approved, which is good. It also means somebody is doing additional work to produce that result. Measuring both lets the practice preserve what's working while identifying where the process could be easier. ## Keep track of each clock It's useful to think about a prior authorization as several clocks rather than one turnaround time. The first clock begins when the provider identifies the need for a procedure and ends when the request is submitted. The second begins when the payer receives the request and ends with its initial decision. If the request isn't approved on the first pass, a third clock measures how long the additional information, appeal, or peer-to-peer takes. Those clocks point to different problems. Imagine a doctor sees a patient and determines that the patient probably needs surgery or an MRI. The staff may not be able to initiate the prior authorization at that moment because the payer will require the clinical note. The authorization has to wait until the provider finishes the note and makes it available. Coding can create another delay. So can the way the practice organizes the work. We've generally seen two approaches: 1. Just in time. The medical assistant initiates the authorization as soon as they know it will be required. This keeps the time down, but it becomes another thing the staff member has to remember while going through the day. 2. In bulk. Staff collect the requests and process them on a daily or weekly cadence. This may make the work easier to organize, but it creates a built-in delay before the request reaches the payer. If a procedure is scheduled far enough out, a short internal delay might not create a real problem. If the authorization doesn't go out cleanly or get approved easily on the first pass, that same delay eats into the window available to resolve it. Ideally, the time between having a complete, submission-ready request and actually sending it to the payer should be as close to zero as possible. ## Separate practice delays from payer delays Payer delays are part of life, and they aren't always fixable. We once encountered a payer that required prior authorizations to be initiated over the phone while its phone system was down. No improvement inside the provider's office could have made that payer answer the phone. But most delays aren't that irreducible. Messy or poorly organized notes can slow down the review. If the notes don't contain the language the payer is looking for, the payer might ask for additional information that was already sent. At worst, it can deny the request and force the physician to spend time on a peer-to-peer just to explain what could have been clear in the original documentation. Routing errors can waste even more time. In one real case, a payer accepted a prior authorization request for a patient who didn't have active coverage, held the request for almost two weeks, and then denied it. A proper eligibility check before submission could have prevented that entire wait. The point of separating the clocks is to tell the difference. Time between the provider's decision and submission generally points to documentation, coding, queuing, or another internal issue. Time between submission and determination may point to the payer, but requests for additional information, routing problems, and interim denials can still reveal problems with the original submission. ## Use the median and the percentiles Average turnaround time can be distorted by a small number of extremely long cases. Payers can be very slow, become backlogged, or make mistakes. Those outliers aren't necessarily evidence of a deficiency in the provider's office. The median is a better way to describe what happens in a typical case. Pairing it with the 80th or 90th percentile also shows how long the slower group of cases is taking without letting one extraordinary case dominate the entire report. That longest-running subset is worth reviewing carefully. Ask: - Where did the delay occur? - Was it before or after submission? - Did the request go through a complicated review process? - Was there an appeal, and how long did it take? - Did scheduling the peer-to-peer create additional delay? Focus first on making sure most procedures go right most of the time rather than getting hung up on outliers. The median tells you how the usual process is performing. The higher percentiles give you a manageable group of difficult cases to investigate. ## Measure where staff time goes Turnaround time measures what the patient and practice experience. It doesn't necessarily measure how much staff work went into getting there. Practices should also track how often requests involve additional information, interim denials, appeals, and peer-to-peers. It can be helpful to count the number of staff touches required to resolve a case. The submission method matters too. Keep track of the proportion of authorizations handled through portals, phone calls, and faxes, along with the time spent using each channel. Staff sometimes call when a portal or fax would have worked just as well. Measuring the duration by submission method makes it much easier to see where their time is going and whether a less expensive route is available. Break these metrics down in whatever way reflects how the organization operates. That may be by: - Payer - Procedure - Provider - Location - Submitter - Submission channel We recommend centralizing prior authorization submission when possible because it makes improvements easier to implement. A centralized team can change one process once. When the work is distributed across many locations and staff members, the same improvement has to be taught and maintained in every place. Even in a centralized process, breaking down the data can reveal useful patterns. If one provider's requests consistently sit for a week between the encounter and submission, the practice can look at when the notes become available. If one payer produces much longer phone calls, staff can determine whether another submission route is available. If one procedure generates frequent additional information requests, the practice can improve the documentation checklist for that procedure. ## Be curious, not furious When the report reveals a slow provider, location, submitter, or payer, the administrator's job is to figure out what's actually going wrong. It's easy to point fingers. It's much harder to fix the cause of the problem. Payer mix matters, and one team may simply be dealing with a payer that's unusually slow or difficult. Staff are generally working very hard, and a metric without context can assign blame to the person who is actually cleaning up the hardest cases. Be curious, not furious. Look at the underlying cases, make sure your own house is clean, and identify the part of the process that can actually be changed. That's how we treat authorization issues at Davner. Every preventable delay or denial is a chance to improve the system for every authorization that follows. For example, we found that some payer systems were struggling to read the faxes being sent to them. We changed the fonts and font sizes to make our faxes easier for optical character recognition systems to read and route. Now every outbound prior authorization fax we send benefits from what we learned. Staff don't have to remember a new workaround for the next patient. The first step is keeping a report of any kind. Many practices don't track these metrics at all, even though keeping track of how an authorization gets approved can be just as important as keeping track of the final result. Once the numbers identify a preventable problem, the best response is to eliminate that problem as categorically as possible. The goal isn't a better-looking dashboard. It's to make sure the next authorization is done correctly, every time, as quickly as possible. ## Spend less time chasing prior authorizations Let Davner handle the work behind each approval, so your team can stay focused on patients. [Schedule demo](https://davner.com/book)