How a five-minute prior auth becomes 20 minutes
A midsize orthopedic practice orders an MRI for a patient with a suspected rotator cuff tear. The authorization specialist gathers the patient and coverage details, order, codes, and supporting clinical records from the EHR.
After the specialist enters the case and uploads the records, the payer portal may redirect them to another portal or a phone line. The same information must be provided again, and again, and again until the request reaches the right channel. By then, a five-minute submission has taken 20 minutes.
That is where much of the avoidable work in prior auth hides: not in the clinical decision, but in carrying the same case through systems that do not carry it forward for the team.
Eight out of ten orthopedic practices we talk to raise this problem. One team worked across roughly ten imaging portals and another five or six for physical therapy. The most frustrating cases were often not the most clinically complex, but the ones that required the same work in multiple systems.
We used to manually re-enter the same prior-auth information across multiple forms. Until Clicks Health.
Blue Cross and Blue Shield of Illinois offers a useful example. Its current provider guidance tells practices to check eligibility and benefits first because the correct authorization pathway can depend on the member and service. Some requests are handled by BCBSIL through BlueApprovR or Availity, while others go through Carelon or eviCore. See BCBSIL's current guidance for requesting prior authorization.
The routing can change. The prior-auth specialist should not have to track every pathway or re-enter the case each time it moves between systems.
From 20 minutes of staff time to zero
Trying to encode every payer rule into a permanent routing map is unlikely to hold up for long. Plans, vendors, portals, and requirements change. A more durable automation opportunity is to carry the work forward once the next step is known.
Computer-use automation can work through the same EHRs, payer portals, PDFs, and desktop applications that authorization teams already use, and it can place calls to payers when the workflow requires one. On a payer call, the agent can navigate the IVR, provide the case details, capture the outcome and reference number, and log the result in the EHR.
Patient data, orders, and codesare joined with supporting records.
Portal entry and payer callsare handled in the same workflow.
Status and confirmation detailsare returned automatically.
The completed submission, status, and confirmation number are logged in the EHR automatically, giving the team a clear record without another round of manual entry.
Where to start
The best place to start is a workflow your team wants off its plate. Look for three signals:
- The team consistently describes the workflow as repetitive, frustrating, or something they try to avoid.
- The workflow happens often enough that the time savings compound.
- Most cases use existing EHR data and do not require patient or clinician input.
How to get started
You pick a workflow to automate
Show us the repetitive work.We learn it from real cases.
Clicks builds a custom agent
We map the process and define success.Then we build and train the agent.
Your team gets to focus on patients
The agent handles the repetitive work.Completed work returns to your team.
Take repetitive prior-auth work off your team's plate
Show us the workflow. We standardize it, build the agent, and guarantee the outcome.
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