Delayed Payments from Pending Prior Authorizations
Definition
Slow prior authorization approvals delay claim submissions and reimbursements, inflating Accounts Receivable days. Providers must chase statuses every 48-72 hours, prolonging cash conversion cycles. Systemic payer-provider friction causes ongoing drags.
Key Findings
- Financial Impact: Not quantified; tied to high AR days from delays
- Frequency: Weekly
- Root Cause: Payer turnaround delays and lack of real-time status tracking
Why This Matters
This pain point represents a significant opportunity for B2B solutions targeting Hospitals.
Affected Stakeholders
AR specialists, billing teams, finance directors
Deep Analysis (Premium)
Financial Impact
$1,200,000-$1,800,000 annually from 7-10 additional AR days on 300-bed hospital (average claim $4,000) • $10,000+ in delayed reimbursements per delayed case due to inflated AR days • $10,000+ monthly in delayed reimbursements per 10 delayed claims at avg $1K each.
Current Workarounds
AR Manager must request documentation from clinical team (physicians, nurses); documentation is retrieved manually from paper charts or EHR; resubmission redone via fax/portal; appeal letter manually drafted • AR staff maintain manual log of WC PAs submitted to different carriers and third-party administrators (TPAs); staff call TPAs directly to check status; some use sticky notes on monitors to track high-value claims • Budget Analyst correlates ED admission volume with AR aging data; calculates lost ED revenue tied to PA delays; presents to CFO as variance explanation; uses historical ED-to-PA correlation to model future impact
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Methodology & Sources
Data collected via OSINT from regulatory filings, industry audits, and verified case studies.
Related Business Risks
Denied Claims from Prior Authorization Delays and Failures
Administrative Staff Overtime and Resource Waste in PA Processing
Patient Care Delays and Idle Capacity from PA Bottlenecks
Patient Treatment Delays and Churn from PA Friction
Manual Delays and Idle Billing Resources from Charge Capture Bottlenecks
Incorrect Coding Leading to Fraud and Abuse Penalties
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