The 7 Most Annoying Prior Auths - And How an AI Agent Can Fight Them for You

Rohan Handa

Rohan Handa

— 3 min read
The 7 Most Annoying Prior Auths - And How an AI Agent Can Fight Them for You

Prior authorizations are the worst.

They delay care. They frustrate staff. They require logging into portals that haven’t been updated since 2004. And even when you do everything right, they still get denied.

We asked our RCM partners across 50+ practices: What are the most annoying prior auths you deal with every week? Here’s what they said - and how AI agents can help tackle each one.

1. MRIs for Joint Pain (Especially Knees)

The pain:

  • Requires conservative treatment documentation (PT notes, NSAIDs)
  • Rejected if imaging done "too early"
  • Often requires peer-to-peer review

AI fix:

  • Agent scrapes EHR for PT note references
  • Auto-assembles clinical summary
  • Uploads to payer portal with ICD-10 mapping
"Used to take 3 days. Now it’s prepped and submitted same day."

2. Sleep Studies for Suspected Apnea

The pain:

  • Payer wants multiple months of sleep logs
  • Missed comorbidity codes = automatic denial

AI fix:

  • Pulls historical visit data for BMI, fatigue, hypertension
  • Flags missing indicators
  • Attaches notes + generates auth-ready summary

3. Specialty Meds: Biologics or Injectables

The pain:

  • Payer-specific forms
  • Documentation of step therapy failure
  • Long call times for status checks

AI fix:

  • Fills in payer forms automatically (PDF parser + filler)
  • Cross-checks formulary requirements
  • Monitors portal daily and logs auth status
"The AI caught 4 missing step therapy notations in a week. Huge save."

Watch how Nanonets AI Agents are saving time on document work for healthcare providers like yours.

4. CT Scans for Abdominal Pain

The pain:

  • Rejected for lack of physical exam notes
  • Short clinical descriptions get flagged

AI fix:

  • Parses SOAP notes
  • Highlights exam findings
  • Auto-summarizes and uploads to auth portal

5. DME: CPAP Machines or Orthotics

The pain:

  • Requires sleep study + face-to-face visit docs
  • Patient compliance history
  • Claims bounce due to wrong modifiers

AI fix:

  • Gathers supporting clinical + visit notes
  • Applies correct HCPCS codes and modifiers
  • Submits documentation bundle in payer's format

6. Out-of-Network Referrals

The pain:

  • Requires proof that in-network alternatives were exhausted
  • Manual phone calls to justify urgency

AI fix:

  • Documents timeline of previous failed referrals
  • Adds urgency justification + referring provider rationale
  • Schedules callback from payer directly via portal (where supported)

7. Follow-up Imaging within 30 Days

The pain:

  • Flags as "duplicate service"
  • Requires clear narrative for clinical progression

AI fix:

  • Tracks previous imaging reports
  • Pulls clinician notes on symptom evolution
  • Generates cover letter template auto-filled for each patient

Why Prior Auths Drain Your RCM Team

Every one of these requires:

  • Checking payer-specific rules
  • Gathering fragmented documentation
  • Logging into 3-5 different portals
  • Following up by phone or fax
Prior auth tasks consume 13 hours/week per provider on average (source: AMA 2023)

Multiply that across your practice, and you’re easily losing $5,000+ per month in staff time and delayed cash flow.

What Nanonets AI Agents Can Do

  • Scrape payer portals for auth status
  • Pre-fill auth forms with chart data
  • Track expirations and resubmissions
  • Flag missing fields before submission
  • Route tricky cases to human RCM lead

All without disrupting your EHR or staff workflow.

What It Looks Like

{
  "patient": "Jenna Miles",
  "dob": "1989-08-12",
  "procedure": "MRI left knee",
  "diagnosis": "M25.561",
  "docs_attached": ["PT notes", "NSAID trial", "Orthopedic consult"],
  "payer": "BCBS TX",
  "auth_status": "Submitted",
  "last_checked": "2024-03-26T14:32:11Z"
}

This shows up in your agent dashboard, sortable by:

  • Status
  • Time since submission
  • Flagged issues

TL;DR

These are the worst prior auths. You know them. You live them.

But now you don’t have to fight them alone.

AI agents can:

  • Prepare the paperwork
  • Submit the requests
  • Track the follow-ups

So your team can focus on patients, not portals.

Want to see an agent handle your next auth live? Request a walkthrough – we’ll run one with your real use case.

Sources:

  • AMA Prior Authorization Physician Survey (2023)
  • MGMA: Practice Efficiency Benchmarks (2022)
  • Nanonets real-world RCM deployments

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