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- This guide is for multi-specialty groups with 10 or more locations or providers, where prior authorization volume has outgrown the staff assigned to it.
- Most groups know prior authorization is slow. Few know what it costs them in a single number a CFO can act on.
- The cost sits in 4 places: staff hours, denials that go unworked, services patients abandon while they wait, and cash that arrives later than it should.
- Below is a 4-part cost model you can run with your own numbers, a worked example for a 20-provider group, and a guide to deciding which fix fits your volume.
Why Industry Averages Are Not Enough
National surveys tell you prior authorization is a problem. The 2025 AMA Prior Authorization Physician Survey found that practices complete an average of 40 prior authorizations per physician each week, and physicians and their staff spend 13 hours a week on that work. Those numbers are useful benchmarks. They do not tell a CFO what prior authorization costs a 20-provider group running cardiology, orthopedics, gastroenterology, and imaging under one roof.
That number depends on your specialty mix, your payers, and how your team works today. A group with heavy imaging and infusion volume carries a different cost than one weighted toward office visits. The only way to see your cost is to model it.
The 4 Places Prior Authorization Delays Cost You
Staff capacity
Every request takes time to prepare, submit, chase, and document. That time comes out of work your team could spend with patients, on the phone, or on the claims that need a person.
Denials that never get worked
A denied request that nobody appeals before the deadline becomes lost revenue. In most groups, this is the largest and least visible line.
Services patients abandon
When an authorization stalls, the appointment moves. Some patients reschedule. Some go elsewhere, and some never return.
Slower cash
A service that waits on approval gets billed later. Across thousands of requests, that delay adds days to accounts receivable.
The Cost Model
Use your own data where you have it. Where you do not, use the national benchmarks as a starting point and replace them once you have 1 quarter of tracked volume.
The 4 calculations:
- Staff capacity cost = annual requests × hours per request × loaded hourly cost
- Unworked denial cost = annual requests × denial rate × share never appealed × average reimbursement
- Abandoned service cost = annual requests × share delayed × share abandoned × average reimbursement
- Cash delay: track days from order to authorization to billing, and compare against your groups that move fastest
Worked Example: A 20-Provider Multi-Specialty Group
The inputs below are illustrative assumptions for a group running cardiology, orthopedics, gastroenterology, and imaging. Your numbers will differ.
Staff capacity. 10,000 requests × 0.5 hours = 5,000 hours per year. That equals about 2.5 full-time equivalents of capacity, or $175,000 at a $35 loaded rate.
Unworked denials. 10,000 × 10% = 1,000 denials. If 30% never get appealed, that is 300 services × $1,200 = $360,000.
Abandoned services. 10,000 × 5% = 500 delayed services. If 20% of those patients do not return, that is 100 services × $1,200 = $120,000.
Total annual cost: $655,000, or about $32,750 per provider, before counting the cash delay.
2 things stand out. First, the staff hours are real, but unworked denials cost this group twice as much. Second, the 2 revenue lines both depend on follow-up: chasing a pending request before the appointment slips, and appealing a denial before the window closes. Follow-up is the work that falls off first when a team is stretched.
What Changes the Number Most
Run a sensitivity check on your model. In most multi-specialty groups, 3 inputs move the total more than any other:
- The share of denials that go unworked. Cutting this from 30% to 10% in the example returns $240,000.
- The reimbursement mix. Imaging, procedures, and infusions carry far more value per request than office services, so a few stalled high-value requests outweigh many low-value ones.
- Follow-up speed. Faster status checks shorten delays, which reduces both abandoned services and cash delay.
Which Fix Fits Your Volume
If your model shows unworked denials and abandoned services as the largest lines, a submission-only tool will not close the gap, because the cost sits in the work after submission. Our comparison of prior authorization software solutions breaks down which vendors cover which part.
How Confido Health Handles Prior Authorization
Confido Health is the AI system of action for healthcare operations. Our AI Teammates work alongside staff at specialty and multi-specialty groups to handle the administrative work that keeps patients moving: calls, scheduling, insurance verification, prior authorization, denials, and billing. Every task ends in a documented outcome in your EHR or PMS, not a note for someone to finish later. Confido Health is HIPAA-compliant and SOC 2 Type II certified, and supports 20+ specialties.
What we do for prior authorization
Prior authorization at Confido Health covers the full request lifecycle, not just the submission form:
- Requirement checks. Confirm whether a service needs authorization for that patient’s payer and plan before the appointment is booked.
- Submission. Submit requests through payer and IPA portals and through clearinghouse connections, with the documentation each payer expects.
- Missing information. Reach out to payers when a request comes back incomplete, and gather what they need.
- Status follow-up. Check on pending requests on a set schedule, so a stalled request surfaces before the appointment slips.
- HMO and IPA edge cases. Handle the referral and delegation rules that generic PA tools miss.
- Denials and resubmission. Clarify denial reasons, correct and resubmit requests, and track appeals through to resolution.
- Renewals. Flag expiring authorizations for ongoing treatment before they lapse.
How it works
Every prior authorization follows the same 4 operating principles.
1. Context first. Before acting, the AI Teammate pulls the order, diagnosis, payer, plan, and history from your EHR or PMS. Nothing starts from a blank form.
2. Rule-based decisions. Your payer rules, specialty requirements, and escalation thresholds set what the AI Teammate does at each step. Your team approves the rules during setup, and the AI Teammate follows them on every request.
3. Direct write-back. Each status change, payer response, and resubmission writes back to your EHR or PMS as it happens. Your staff sees one record, not a separate tool to check.
4. Deliberate escalation. When a request needs clinical judgment, such as a peer-to-peer review or a medical necessity argument, the AI Teammate routes it to the right person with the full case attached. Your team spends its time where a clinician or specialist adds value.
What this changes in your cost model
Return to the 4 cost lines from earlier:
Groups using AI-supported prior authorization report up to 75% faster end-to-end processing and 30% fewer initial denials compared with manual workflows.
Live in weeks, not quarters
Confido Health integrates with 50+ EHR, PMS, and phone systems. Groups typically go live in under 30 days, starting with the workflows their cost model flags as largest.
Run Your Own Number
Send us your prior authorization volume, specialty mix, and denial rate, and we will build your cost model with you.
Frequently Asked Questions
How much do prior authorization delays cost a multi-specialty group?
It depends on volume, specialty mix, and denial follow-up. In our illustrative 20-provider example, the annual cost came to about $655,000. To find your number, use the worksheet in this guide, or send Confido Health your prior authorization volume, and we will build your cost model with you.
What is the highest hidden cost of prior authorization?
In most groups, it is denials nobody appeals. They rarely show up as a line item, but they often exceed the cost of the staff time spent on requests. Confido Health AI Teammates classify denials, file appeals, and resubmit corrected claims before deadlines pass, so fewer denials expire unworked.
What data do I need to calculate my prior authorization cost?
You need 7 inputs: requests per provider, staff time per request, loaded hourly cost, denial rate, share of denials never appealed, share of delayed services patients abandon, and average reimbursement per service. Most groups can pull these from their PMS and payer remits in 1 quarter.
How can a multi-specialty group reduce prior authorization delays without adding staff?Focus on follow-up first, since stalled requests and unworked denials drive most of the cost. Confido Health AI Teammates submit requests, follow up with payers while a request is pending, and write every update back to your EHR or PMS. Your staff can then spend their time on the cases that need clinical judgment.
Does the CMS prior authorization rule reduce these costs?
It may help over time. The rule requires Medicare Advantage, Medicaid, CHIP, and federal marketplace plans to support electronic prior authorization and meet decision timeframes, with API requirements taking effect in January 2027. It does not cover commercial employer plans, and it does not work denials or follow up on your behalf.
