Prior authorization services manage the approval process payers require before certain treatments, procedures, or medications are covered, tracking documentation, submission, and follow-up so care is not delayed by an avoidable paperwork gap. Zeerak Care provides prior authorization support for U.S. healthcare providers that need this process handled accurately and tracked against increasingly complex, frequently changing payer rules.
The burden here is real and well documented. RAND’s July 2025 analysis found that physicians complete an average of 43 prior authorizations per week, spending more than 16 hours on forms, hold calls, and appeals, time that comes directly out of patient care rather than spare capacity.
– The Problem We Solve
Incorrect coding, missing details, and claim errors lead to denials, delayed reimbursements, and ongoing revenue loss.
Your staff spends hours on claims, follow-up, and payment tasks instead of supporting patients and operations.
Without clear billing reports, you cannot track collections, spot revenue leakage, or monitor reimbursement performance.
Unworked claims and slow payer follow-up increase aging A/R, delay payments, and weaken your practice cash flow.
Missing eligibility checks and prior authorization errors cause avoidable denials, billing delays, and extra staff pressure.
Payer rules, coding updates, and billing requirements are complex, time-consuming, and difficult to manage consistently.
– Our Solutions
Prior authorization services manage the approval process a payer requires before it will cover a specific treatment, procedure, medication, or piece of durable medical equipment. This includes verifying which services need authorization for a given plan, submitting documentation that supports medical necessity, tracking the request through the payer’s review timeline, and following up when a decision is delayed or denied.
MGMA’s Annual Regulatory Burden Report found that 92 percent of surveyed medical group practices have hired or reassigned staff specifically to handle prior authorization volume, and 60 percent of practices say at least three employees are typically involved in completing a single request. This is not a minor administrative task bolted onto billing. For many practices, it is now a dedicated staffing function in its own right.
The scale of the problem is well documented across multiple independent sources. Beyond the 43 requests per week and 16-plus hours RAND found physicians spending on prior authorization, roughly 80 percent of physicians report that the process has led patients to abandon necessary care altogether, and a KFF Health Tracking Poll found that 58 percent of insured adults who needed prior authorization for specialized care experienced either a delay or a denial as a result.
Denials tied to prior authorization gaps are also rising, not falling. Recent industry analysis found prior authorization denials increased 31 percent year over year in 2026, even after a major federal rule intended to speed up the process took effect. Part of this comes from payers expanding the list of services that require authorization, and part comes from the same annual code churn that affects billing broadly: 288 new CPT codes went live January 1, 2026, and 614 new ICD-10-CM codes took effect October 1, 2025, and a prior authorization submitted against an outdated code gets rejected regardless of clinical merit.
The CMS Interoperability and Prior Authorization Final Rule, CMS-0057-F, introduced real timeline requirements starting January 1, 2026. Standard, non-urgent prior authorization requests from covered payers now require a decision within seven calendar days, down from the often open-ended timelines practices dealt with before, and any denial must include a specific reason regardless of which channel the request came through. Covered payers must also begin publicly reporting prior authorization metrics annually, with the first reports covering 2025 due by March 31, 2026.
This rule does not apply to every payer. It covers Medicare Advantage organizations, Medicaid managed care plans, CHIP managed care entities, state Medicaid and CHIP fee-for-service programs, and qualified health plan issuers on federal exchanges. Commercial fully-insured plans, self-funded employer plans, and standalone Part D plans fall outside its requirements, which means a practice’s prior authorization workflow still needs to track which payers are, and are not, bound by these new timelines.
Zeerak Care verifies which services require authorization for each patient’s specific plan at the point of scheduling, not after the visit has already occurred. Documentation supporting medical necessity is prepared and submitted according to each payer’s format, whether that is an electronic portal, a fax-based process, or increasingly, a FHIR-based API submission under CMS-0057-F requirements. Requests are tracked against payer-specific decision timelines, with active follow-up on anything approaching a deadline without a response, and denied requests are routed for appeal with the specific denial reason payers are now required to provide.
This coordinates directly with eligibility verification, since authorization requirements are typically confirmed in the same front-end check that verifies coverage and benefits, and with our denial management services for authorization-related denials that require a formal appeal.
Public data now available under CMS-0057-F shows standard prior authorization denial rates ranging from under 2 percent to above 27 percent across different payers and plan types, which means the payer mix a practice deals with has a direct, measurable effect on how much prior authorization risk it is carrying. A workflow that treats every payer the same misses this variation entirely.
The most effective reduction in prior-authorization-related denials comes from verifying requirements before the appointment, using current code sets rather than ones that predate the most recent CPT or ICD-10 update, and tracking each payer’s actual decision timeline rather than assuming a uniform turnaround across the board.
Prior authorization services benefit specialty practices where a high share of services require authorization, practices with a significant Medicare Advantage or Medicaid managed care patient population given how concentrated authorization requirements are in those plan types, and any practice where staff are currently pulled from clinical support duties to manage authorization paperwork, matching the pattern MGMA found across the vast majority of surveyed practices.
Zeerak Care tracks prior authorization requirements payer by payer rather than applying a single generic process, keeps pace with CMS-0057-F’s new decision-timeline requirements and annual code updates, and coordinates authorization status directly with eligibility verification and denial management so a gap in one does not silently become a denial in another. We deliver this at 40 to 50 percent lower cost than many U.S. billing firms, without the burden falling on your clinical staff’s time.
Prior authorization services manage the approval process a payer requires before certain treatments, procedures, or medications are covered, including verifying requirements, submitting documentation, tracking decisions, and handling appeals when needed.
RAND’s 2025 research found physicians complete an average of 43 prior authorizations per week, spending more than 16 hours on forms, hold calls, and appeals, and MGMA found 92 percent of practices have hired or reassigned staff specifically for this workload.
Under CMS-0057-F, standard prior authorization decisions from covered payers must now be made within 7 calendar days, and denials must include a specific reason. This applies to Medicare Advantage, Medicaid managed care, CHIP, and federal exchange qualified health plans, but not commercial fully-insured or self-funded employer plans.
Denials rose 31 percent year over year in 2026 due to payers expanding which services require authorization, combined with hundreds of new CPT and ICD-10 codes that outdated submission templates do not account for.
Yes. Public CMS-0057-F data shows standard denial rates ranging from under 2 percent to above 27 percent depending on the payer and plan type, which is why a uniform, one-size-fits-all authorization workflow misses significant payer-specific risk.
Authorization-related denials, whether from a missing approval or an expired one, are routed into denial management for root-cause correction and appeal, since simply resubmitting the same request without addressing the underlying gap tends to produce the same result.
If prior authorization is pulling your clinical staff away from patient care, or delayed approvals are slowing treatment, Zeerak Care can help. Our prior authorization services are built to track payer-specific requirements and the current CMS-0057-F timelines so approvals move faster and denials happen less often.
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