How prior authorization services work and how to choose one

A prior authorization service takes the payor approval step off a practice’s own staff. It submits each request with the clinical documentation the payor asks for and follows it through to a decision.

Volume is what pushes most practices to look outside. Physicians complete an average of 40 prior authorizations a week, which take 13 hours of physician and staff time, according to the AMA’s May 2026 survey of 1,000 physicians.

At a glance

• Practices outsource the work to staffing or billing firms, to software their own staff run, or to platforms such as Silna that do the work.
• Paying an in-house specialist the BLS median comes to about $72,600 a year once benefits and payroll taxes are added, based on BLS data for 2025 and 2026.
• Providers differ most on turnaround by payor and on how much denial work comes back to the practice.
• 79% of physicians report patients abandoning treatment because of authorization problems, per the AMA’s 2026 survey.
• ABS Kids generated more than $1 million in annual value from its partnership with Silna, per the ABS Kids case study.

What a prior authorization service handles

A service takes on the same tasks an in-house specialist would, run by an outside team or system.

• Checking which scheduled services need authorization under each patient’s plan and what each payor evaluates
• Preparing requests with the clinical documentation a medical necessity review requires
• Submitting requests through payor portals, electronic transactions, fax or phone
• Following up on pending requests and resubmitting when documentation is missing
• Handling denials and appeals
• Recording approvals, reference numbers and expiration dates in the EHR

Services differ in how much of that list they cover. Some submit and track requests and return denials to the practice, and others carry each request from the first coverage check to the final decision.

Keeping prior authorization in-house or outsourcing it

The table shows who does the work under each option and what stays with your own staff. Tools a practice’s own staff run are reviewed in Silna’s comparison of prior authorization software.

What in-house prior authorization staff cost

One in-house prior authorization specialist costs about $72,600 a year at the median wage, including benefits and payroll taxes, before recruiting and cover for absences. Two in five physicians employ staff who work only on prior authorization, according to the same AMA survey.

The figure comes from two BLS sources. The Bureau of Labor Statistics does not track the role separately, and its closest occupation, medical records specialists, had a median wage of $51,140 in May 2025, per the BLS Occupational Outlook Handbook. Benefits and payroll taxes made up 29.6% of total compensation in health care and social assistance in June 2026, per the BLS Employer Costs for Employee Compensation release. With wages as the remaining 70.4%, a $51,140 wage means a total cost of about $72,600.

That figure is the baseline for any outsourcing quote. A staffing contract replaces the salary with a rate for staff time. Software adds a subscription while the salary stays. A platform that does the work replaces most of that staff time with its own fee.

How to compare prior authorization companies

Prior authorization companies are easiest to compare on a few direct questions, and the answers separate providers more clearly than feature lists do.

Published payor data helps only a little. A 2024 federal regulation requires certain insurers to report their prior authorization approval and denial rates, with the first data, covering 2025, due by March 31, 2026. KFF found that the aggregated figures give limited insight into how insurers decide, so each provider’s own turnaround and first-pass acceptance by payor make the more useful comparison.

Denial handling deserves the closest look. Rates vary widely by plan, and in one review 12 of the 115 Medicaid managed care plans examined by HHS OIG denied more than a quarter of requests in 2019. Physicians also report the problem growing, in the AMA’s 2026 survey.

How Silna handles prior authorization

Silna manages prior authorization from start to finish, from tracking upcoming authorizations and weekly reminders to submissions and payor follow-ups. It runs benefit checks and insurance monitoring in the same workflow. Silna is the #1 rated prior authorization solution on G2.

AnswersNow, a virtual ABA therapy provider, moved both its prior authorizations and its benefit checks to Silna, and both now take less time.

Predictive Document Intelligence checks each request against payor requirements before it is submitted. Silna can also update the practice’s EHR with the authorization details that scheduling and billing need.

Which arrangement fits your practice

Each arrangement fits a different kind of practice.

• In-house staff suit a single location with stable volume and a short list of payors, where one specialist can keep pace.
• A staffing or billing firm suits a practice that wants people working its existing process or one vendor for both billing and authorizations.
• Self-serve prior authorization software suits a practice with staff time to spare that needs faster submission and tracking.
• Silna suits practices with several locations or growing volume that want prior authorization and insurance verification handled in one workflow.

Talk to Silna about outsourcing prior authorization

Key terms

Prior authorization service

An outside company or platform that obtains payor approval for a practice’s services before they are delivered.

Prior authorization outsourcing

Moving some or all prior authorization work from a practice’s own staff to an external provider.

Turnaround time

The time from a request’s submission to the payor’s decision.

First-pass acceptance rate

The share of authorization requests a payor accepts on first submission, without a resubmission.

Benefit check

A review of a patient’s coverage, cost share, authorization requirements and visit limits before care begins.

Frequently Asked Questions

What do prior authorization services include?

Most handle each request from the coverage check until the payor decides. Whether appeals and EHR updates are included varies by provider, which is worth confirming before signing a contract.

How much does it cost to outsource prior authorization?

Each provider quotes on its own pricing model, so the practical benchmark is a salaried specialist, who costs roughly $72,600 a year including benefits and payroll taxes when paid the BLS median.

When does it make sense to outsource prior authorization?

Usually when requests back up faster than staff can clear them or when one person’s absence stalls authorizations. Expansion into new locations or new payors is another common trigger.

Can a practice outsource only part of the work?

Yes. Some practices keep clinical documentation in-house and hand off submission and follow-up, and others outsource only certain payors or service lines. Writing the split into the contract keeps any request from falling between the two teams.

What is another name for prior authorization?

Payors and practices also call it preauthorization, precertification or prior approval. Each term describes the same check of medical necessity before a service is delivered.

This article is general educational information and does not give medical or insurance advice. Coverage rules and clinical criteria vary by plan and state, so consult a licensed healthcare professional or your plan administrator about your specific situation.

About the author

Jeffrey Morelli

Jeffrey Morelli is the Co-Founder and CEO of Silna Health, the first Care Readiness Platform built to remove the administrative barriers that delay care. Silna automates benefit checks, eligibility, and prior authorizations across 1,000+ payors, and is backed by $27M from Accel and Bain Capital Ventures. Before Silna, Jeff spent a decade in San Francisco building and scaling products for highly regulated industries, including leading go-to-market at Truework (Series C, acquired by Checkr).

Last updated: October 12, 2026.