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A major hospital system automated prior authorizations, freeing staff from administrative burdens and accelerating patient care.
- MetroHealth increased monthly authorization transactions by 173%, from 2,200 to 6,000.
- Staff now work 30 days ahead of scheduled services, a 114% increase in available time.
- The average time spent on each authorization request dropped from 10 minutes to under 4.
- follow-up times were cut by 50%.
- Peer-to-peer reviews now happen 4-5 days sooner.
For hospitals, prior authorizations are a necesary evil. But what happens when the volume of requests overwhelms staff, delaying care and creating financial headaches? MetroHealth, serving over 300,000 patients annually, faced exactly that challenge. Manual processes-endless phone calls and navigating payer portals-simply couldn’t keep pace with demand. Automating prior authorizations is key to streamlining workflows and improving patient access to necessary procedures.
The problem wasn’t a lack of effort, but a lack of scalability. MetroHealth staff spent valuable time chasing down approvals, often discovering denials late in the process. This created a frantic scramble for updates, pushing back appointments and leaving patients waiting longer for the care they needed. Beyond the impact on patient experience, the growing workload increased the risk of claim denials, resulting in lost revenue and increased administrative costs.
A Solution that Runs in the Background
Faced with the impossibility of hiring their way out of the problem, MetroHealth sought a revenue cycle management partner capable of handling their authorization volume and reducing reliance on manual tasks. They needed a vendor with strong connections to payers and robust automation technology. Experian Health’s authorizations solution was implemented with a focus on accuracy from the start.
From Firefighting to Proactive Management
The results for MetroHealth were dramatic. Monthly authorization transactions soared by 173%, jumping from 2,200 to 6,000. Teams now work 30 days ahead of scheduled services-double the previous window of 14 days-providing crucial breathing room. The average time spent on each authorization request plummeted from 10 minutes to just under 4, and follow-ups are now 50% faster thanks to automated status checks.
The shift wasn’t just about volume. Staff are no longer bogged down in repetitive data entry or portal navigation,allowing them to focus on exceptions and cases requiring more attention. Initiating authorizations 30 days before the scheduled service allows for proactive case management, preventing denials and delays.
This increased capacity enabled the same team to handle a significantly larger workload-from roughly 2,200 to 6,000 authorizations per month-supporting more service lines and higher patient volumes without additional staffing. The system reliably captures the necessary details and keeps requests moving forward.
Clinically, the 60% reduction in time spent on authorizations and faster peer-to-peer reviews translate to quicker decisions for patients and less administrative burden for busy clinicians.
Keys to Triumphant Implementation
MetroHealth’s success highlights that improving authorizations isn’t about demanding more from staff, but about creating time and capacity for efficient work. The management team identified three key factors: bringing the right people into the process from the start to ensure alignment, making data easily accessible (such as embedding CPT codes directly into the system), and investing in comprehensive training and ongoing interaction.
Learn more about how Experian Health’s Authorizations solution can reduce manual effort and optimize cash flow.
