The Link Between Eligibility Verification and Prior Authorization Success

In today’s healthcare landscape, prior authorization (PA) remains one of the most significant administrative bottlenecks for providers. According to the American Medical Association (AMA), 88% of physicians report prior authorization burdens lead to delays in care, and nearly 34% say it has resulted in a serious adverse event for a patient. Yet one overlooked factor that directly impacts PA success is eligibility verification.

Too often, providers treat eligibility verification and prior authorization as separate tasks. In reality, they are two sides of the same coin—and when integrated, approval rates increase dramatically, denials decrease, and revenue cycles accelerate.

As a leading Prior Authorization Services Company, Finnastra ensures these processes work seamlessly together to help providers deliver care without administrative obstacles.

Why Eligibility Verification Matters Before Prior Authorization

Eligibility verification is the process of confirming a patient’s insurance coverage, benefits, copays, deductibles, and plan-specific rules before initiating a PA request. Missing or inaccurate eligibility data is one of the top five reasons prior authorizations are delayed or denied.

• 70% of claim denials stem from eligibility issues, according to MGMA (Medical Group Management Association).
• Providers lose an estimated $30 billion annually in revenue due to eligibility-related errors and downstream denials.
• Staff often spend up to 20 minutes per patient verifying benefits manually, increasing operational costs and slowing patient access to care.

When eligibility verification is inaccurate, prior authorization requests are often submitted to the wrong payer, with incomplete benefit details, or under the wrong coverage guidelines—leading to denials that could have been avoided.

The Connection Between Eligibility Verification and PA Approval Rates

Industry data shows a direct link between proper eligibility verification and higher PA success rates:

• Practices that integrate eligibility verification into their PA workflows see denial rates drop by up to 45%.
• Verified eligibility data ensures that 100% of prior authorization submissions include accurate coverage details, reducing payer pushback.
• Integrated systems accelerate approval timelines, with many providers reporting approval in 1–2 days instead of 5–7 days.

Example: A multi-specialty clinic in Washington implemented an integrated eligibility + PA system and saw their denial rate cut in half within 90 days, while staff time spent on rework dropped by 35%.

The Financial Impact of Poor Integration

Failing to integrate eligibility verification and prior authorization not only delays care—it impacts the bottom line.

• Every denied claim costs an average of $118 in rework, according to Change Healthcare.
• Providers risk lost revenue of up to 3–5% of annual collections when eligibility errors cascade into denied or delayed prior auths.
• Administrative staff burnout rises as teams handle repetitive eligibility corrections and resubmissions, contributing to turnover costs that average $40,000 per staff member.

When eligibility verification and prior authorization are siloed, providers pay the price in both patient outcomes and revenue.

How Finnastra Solves This Problem

At Finnastra, our Prior Authorization Services are designed to simplify the entire workflow by seamlessly integrating eligibility verification services with medical prior authorization services.

Here’s how we ensure success:

1. Real-Time Eligibility Verification
   • We confirm coverage and benefit details before every PA submission, ensuring accuracy from the start.
2. Integrated Prior Authorization Processing
   • As a leading Prior Authorization Services Company, Finnastra ensures that eligibility data directly feeds into PA requests, eliminating redundant work and guesswork.
3. Reduced Denials, Faster Approvals
   • Our clients see approval rates increase by up to 40% and denial-related write-offs reduced by thousands per month.
4. Scalable Support
   • Whether you’re a hospital system, ASC, or specialty practice, our solutions scale to handle high-volume PA requests without overburdening your in-house team.

Key Questions for Healthcare Executives

If you’re a healthcare leader, ask yourself:

• How often are your PAs denied due to eligibility-related issues?
• Do your staff spend more time fixing errors than advancing care delivery?
• What percentage of your revenue is lost to eligibility-driven denials?

If these questions highlight challenges in your organization, it’s time to rethink your workflow.

The Bottom Line

Eligibility verification is not just a front-desk formality—it is the foundation of prior authorization success. When executed correctly and integrated into PA workflows, providers gain faster approvals, fewer denials, and stronger revenue performance.

When you work with a dedicated Prior Authorization Services Company like Finnastra, you get a partner who eliminates these pain points, accelerates approvals, and safeguards your revenue cycle.

Ready to improve your PA approval rates and reduce denials?
Visit Finnastra Prior Authorization Services and discover how we can help you streamline eligibility verification and prior authorization for maximum efficiency and profitability.