How Long Does It Take to Get a Prior Authorization?

Summary

Most prior authorizations are approved within 3 – 5 business days for standard requests, 24 – 72 hours for urgent care, and 10 – 15 business days for complex or high-cost treatments.

The exact time depends on:

• The type of procedure, test, or medication.
• How complete the submitted documentation is.
• The insurance company’s review process.
• Whether the provider uses electronic submission or manual methods.

Delays are often caused by missing documentation, slow submission methods, or payer review processes. Providers can speed up approvals by sending accurate and complete requests, using payer portals or electronic submission, checking insurance coverage early, and tracking requests daily. Reliable prior authorization services can help practices reduce delays and keep patient care on schedule.

What is Prior Authorization?

Prior authorization is when a healthcare provider gets approval from a patient’s insurance company before giving certain treatments, tests, or medications. This step is meant to confirm that the service is medically necessary and will be covered under the patient’s plan.

The time it takes to get a prior authorization can make a big difference for both patients and providers. For patients, delays can mean waiting longer to start important treatments or receive needed medications. For providers, these delays can disrupt the care schedule, create extra paperwork, and even affect payment timelines. Understanding the prior authorization process is key to avoiding unnecessary holdups and working toward faster prior authorization approval.

When handled efficiently, prior authorization helps ensure that treatments are approved before they start, reducing the risk of unexpected bills and helping providers keep the care process smooth from start to finish. However, when requests get stuck or insurance companies take too long to respond, it can lead to frustration, missed appointments, and even common medical billing denials later on.

Average Timeframes for Prior Authorization

The time it takes to get a prior authorization depends on how urgent the request is, the type of service, and the insurance company’s process. Knowing these timeframes can help both patients and providers plan ahead and avoid last-minute delays.

1. Urgent or Expedited Requests

If a patient’s health could seriously worsen without immediate treatment, the provider can request an urgent or expedited review. In most cases, insurance companies aim to respond within 24 to 72 hours. Approvals are often faster when the request is well-documented and the insurance eligibility check is done correctly. Using the best practices for verifying insurance eligibility ensures all details are accurate before submission, which can make a big difference in urgent cases.

2. Standard or Routine Requests

For most medical services and non-urgent treatments, the approval process takes longer. On average, 3 to 7 business days is common. This timeframe applies to regular diagnostic tests, outpatient procedures, and non-emergency prescriptions. Providers who plan ahead submit requests early, monitor their progress closely, and stay in regular contact with the payer to keep the approval process on track.

3. Complex or Special Cases

Some requests are more complicated and can take several weeks to approve. These often involve high-cost treatments, specialized medications, or procedures that require multiple layers of review. Complex requests may also need supporting documentation from more than one provider or specialist. Understanding the provider credentialing process and knowing the payer’s specific requirements can help speed up these cases and work toward faster prior authorization approval.

Factors That Affect Prior Authorization Timelines

The time it takes to complete the prior authorization process can vary widely. Even two similar requests may have different approval times because of certain factors. Knowing these can help providers plan better and work toward faster prior authorization approval.

1. Type of Service, Procedure, or Medication

Some treatments and tests are approved more quickly because they are routine or have clear medical guidelines. Others, like expensive surgeries, specialized medications, or new therapies, may need extra review. High-cost drugs, for example, often require the insurance company to check if lower-cost alternatives have been tried first. This can add days or weeks to the approval time.

2. Completeness of Documentation

Missing or incomplete paperwork is one of the main causes of prior authorization delays. Every insurance company has its own checklist, and leaving out even one required form or test result can cause the request to be sent back. Having all patient records, test results, and medical notes ready at the time of submission increases the chances of faster approval.

3. Payer/Insurance Company Policies

Each insurance company follows its own rules and timelines. Some respond to urgent or expedited requests within a day, while others may take longer. The payer’s internal review process, workload, and how they handle complex cases will affect the timeline. Providers who understand these policies and follow denial management best practices often face fewer delays.

4. Provider’s Submission Process

The provider’s own workflow plays a big role. Practices that use electronic submission tools, verify insurance early, and track the request’s status daily usually see faster results. Those that wait until the last minute or rely on manual paperwork often face setbacks. A smooth process can also reduce the chance of common medical billing denials later.

How to Speed Up Prior Authorization Approvals

Delays in prior authorization can be stressful for both patients and providers. The good news is that with the right approach, many approvals can be obtained much faster. Here are some proven ways to keep the prior authorization process moving and work toward faster prior authorization approval.

1. Submitting Complete and Accurate Requests

Before sending a request, double-check that every required form, test result, and medical note is included. Even small errors, like missing signatures or mismatched patient details, can cause prior authorization delays. Providers who create a checklist for each payer and train their staff on denial management best practices often see fewer rejections and faster responses.

2. Using Payer Portals or Electronic Submission

Many insurance companies now have secure online portals for prior authorization. Submitting electronically is usually quicker than fax or mail because it reaches the right department immediately. These systems often provide instant confirmation and tracking tools, helping the provider monitor progress without repeated phone calls. Combining electronic submission with early insurance eligibility verification can prevent delays before they start.

3. Tracking and Follow-Up Best Practices

Submitting a request is just the first step. The real speed comes from consistent follow-up. Assigning a team member to check request statuses daily ensures that any missing information is addressed right away. Using a follow-up log or task system can help avoid forgotten requests, which can otherwise lead to common medical billing denials or rescheduling patient care.
When providers stay organized and proactive, patients get the care they need sooner, and the practice avoids unnecessary billing issues.

Conclusion

Getting a prior authorization approved can take just a few hours for urgent cases or several weeks for more complex ones. The timeframe depends on the type of service, the completeness of the paperwork, the insurance company’s review process, and how efficiently the provider handles the request.

Working with reliable prior authorization services can make the process smoother. By submitting complete and accurate requests, using electronic tools, checking coverage early, and following up consistently, providers can cut down on delays and keep the approval process moving quickly.

Efficient prior authorization is not just a formality. It helps patients receive timely care, improves health outcomes, and keeps the provider’s billing cycle running without interruptions. When done well, it benefits everyone involved: the patient, the provider, and the practice.