Knowledge Expansion

Prior Authorization Denial Challenges for an Integrated Health System

Fellowship Paper


Matt Smith MPH, FACMPE
This paper documents the challenges faced by an integrated health system with prior authorization claim denials. There is a literature review that outlines the historical burden this has been for medical practices and health systems. There are several examples of how payers make it challenging to prevent claim denials from occurring. The proposed ideas that were possible solutions are discussed in depth. Within those proposed solutions are the pros and cons along with whether they were successful or not. A suggestion for long term sustainability is given as well.
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About the Author

Matt Smith MPH, FACMPE