Solving Prior Authorization Delays: A Finnastra Playbook

Prior authorization (PA) is one of the biggest bottlenecks facing Spravato® providers today. For many practices, it’s not just an administrative burden, it’s a barrier that delays patient care, disrupts treatment plans, and impacts revenue.

Industry data shows that 66% of physicians report waiting at least two business days for PA decisions, and 27% experience waits of a week or longer. For a treatment like Spravato®, where timely care can make a life-changing difference for patients with treatment-resistant depression, these delays are unacceptable.

At Finnastra, we understand that efficient, compliant prior authorization workflows are essential to delivering better patient outcomes and maintaining financial stability. As a leading Spravato Billing Company, we’ve developed a playbook that dramatically reduces PA delays, helping providers start treatments faster while minimizing administrative stress.

The Hidden Cost of PA Delays in Spravato® Practices

Spravato® treatment involves a strict REMS program and significant payer scrutiny. A single delay can cause ripple effects across a practice:

• Patient Harm: Delays in approval leave patients waiting for treatment during critical mental health crises.
• Lost Revenue: Every week a patient isn’t treated means lost billable sessions. For buy-and-bill clinics, this also ties up medication inventory.
• Operational Inefficiency: Staff spend 8–12 hours per week chasing PAs, detracting from patient-facing care.
• Provider Burnout: Navigating complex payer rules leads to frustration and lower staff morale.

Example: A mid-sized psychiatric clinic with 50 active Spravato® patients experienced average PA turnaround times of 12–15 days with their previous billing provider. This resulted in $50,000+ in lost monthly revenue due to delayed treatment starts and expired authorizations.

Why General Billing Companies Struggle with Spravato® PAs

Prior authorization for Spravato® is far more complex than standard psychiatric medications. Most general billing firms lack the specific expertise needed to handle:

• Medication + procedure PAs required for buy-and-bill models.
• Diagnosis-specific coverage rules (e.g., treatment-resistant depression vs. major depressive disorder).
• REMS documentation requirements that must accompany every PA request.
• Payer-specific nuances—Medicare, Medicaid, and commercial insurers each have different criteria.

Without deep knowledge of these rules, generic firms submit incomplete or inaccurate PA requests, triggering denials or endless back-and-forth with payers.

The Finnastra Playbook: How We Solve PA Delays

At Finnastra, our Spravato Billing Services are designed to simplify prior authorization while keeping providers compliant. Here’s how we do it:

1. Streamlined Intake & Documentation

We build customized intake forms to capture all necessary clinical information upfront, eliminating the need for repeat submissions.

• Diagnosis verification using ICD-10 codes like F33.2 and F32.2.
• Treatment history tracking to demonstrate medication failure requirements.
• Integration with REMS compliance documentation.

2. Real-Time Payer Rules Database

Our proprietary database tracks payer-specific rules for Spravato® coverage across Medicare, Medicaid, and commercial plans.

• Ensures first-time approval rates above 95%.
• Automatically flags missing criteria before submission.
• Reduces back-and-forth with payers by up to 70%.

3. Dedicated PA Specialists

Every Finnastra client is assigned a dedicated Spravato® PA specialist who knows their practice, patients, and payers inside out.

• Direct payer follow-up for faster approvals.
• Expedited handling of urgent cases.
• Weekly reporting to track turnaround times and approval rates.

4. Automated Expiration Tracking

Expired authorizations are a common source of denied claims.

• Finnastra’s system tracks expiration dates and initiates renewal requests 30 days in advance.
• Prevents last-minute surprises and treatment interruptions.

Proven Results: Case Study

A Delaware-based clinic transitioned to Finnastra after months of frustration with their prior billing company.

Before Finnastra:

• Average PA turnaround: 14 days
• Approval rate: 78%
• Staff hours spent on PAs: 10+ hours/week

After Finnastra:

• Average PA turnaround: 4 days
• Approval rate: 98%
• Staff hours saved: 30+ hours/month
• Result: $180,000 annual revenue increase due to faster treatment starts and fewer denied claims.

Key Questions to Ask Your Billing Partner

• Are your PAs consistently approved on first submission?
• Does your billing team track payer-specific rules for Spravato®?
• How quickly are urgent cases processed when a patient is in crisis?
• Can they renew authorizations proactively, or are you constantly reacting to expirations?

If you answered “no” to any of these, your practice may already be losing revenue and risking patient care delays.

Why Partnering With a Spravato®-Focused Billing Company Matters?

When you work with a dedicated Spravato Billing Company like Finnastra, you’re choosing a partner that understands both the clinical urgency and the financial complexity of Spravato®.

Our team doesn’t just process claims, we become an extension of your practice, ensuring every patient gets approved quickly, every claim is fully reimbursed, and every treatment session is documented for compliance.

The Finnastra Advantage

As a leader in Spravato Billing Services, Finnastra also brings expertise in TMS Billing and Ketamine Billing, giving us a comprehensive understanding of mental health reimbursement challenges.

Here’s what you can expect:

• 98%+ first-time approval rate for prior authorizations.
• Faster payer responses, average of 3–5 business days.
• End-to-end support, from initial PA requests to claim submission and AR follow-up.
• Revenue-focused reporting so you know your exact ROI.

Final Thoughts

Prior authorization delays don’t just hurt your practice’s revenue, they delay care for patients who need it most. By implementing Finnastra’s proven PA playbook, you can eliminate administrative chaos, speed up treatment initiation, and build a scalable, profitable Spravato® program.

Don’t let payer red tape hold your practice back.
Partner with Finnastra and transform your PA process today.

Learn more about how Finnastra’s Spravato Billing Services can streamline your practice: Spravato Billing Services