Streamlining Referrals and Prior Authorizations in eClinicalWorks: A Guide to Reclaiming Patient Access Capacity

What if the biggest drain on Patient Access capacity isn’t the volume of work, but the work happening be“12tween each step? 

It may not be the referrals coming in or the prior authorizations being submitted. It’s everything that happens after.

Following up with payers. Chasing missing documentation. Checking authorization status. Coordinating with clinical teams. Following up again.

For organizations using eClinicalWorks, these small, repetitive tasks can quickly add up, taking valuable time away from getting patients scheduled and care moving forward.

And as referral volumes grow and payer requirements become more complex, so does the workload. Your staff spend more time chasing PAs resulting in less capacity for patients, slower scheduling and delayed revenue.

The AMA’s recent survey shows that PA continues to be a significant burden on physicians and patients. Physicians reported that PA caused delays in care at least some of the time in 93% of cases, and caused patients to abandon treatment plans at least some of the time in 82% of cases. 

The key is striking the right balance between the time spent authorizing and tracking prior authorizations.

In this guide we’ll take a look at the primary reasons why tracking prior authorizations manually becomes increasingly challenging as your practice grows. 

And explore several workflow improvements for Patient Access teams looking to reclaim staff hours, increase transparency and reduce repetitive administrative follow-up, improve referral and authorization visibility, and support timely scheduling and financial clearance without disrupting everyday operations in eClinicalWorks .

Why Referral & Prior Authorization Have Become Patient Access Challenges?

Referral management and prior authorization are frequently viewed as two distinct processes.

They are actually closely integrated functions within the Patient Access realm. For every patient encounter, there is a front-end revenue cycle that must be followed before billing can even occur.

Any interruption to this process will cause downstream delays.

If you’re using eClinicalWorks, chances are, your staff is checking each patient’s eligibility one appointment at a time. In the early stages, with fewer providers and more limited scheduling, this works just fine. As your practice grows and you add more physicians, locations, and payers, however, those checks become much more challenging. 

Front-office staff members spend hours each day reviewing insurance eligibility for routine procedures as more complex cases involving expired referrals and prior authorizations demand their attention in the days leading up to a patient visit.

The issue is that an appointment-based approach doesn’t scale well as your practice grows. That’s why many organizations are moving towards a batch, pre-visit approach in which staff review a block of upcoming appointments 24 to 72 hours out on a daily basis, only performing eligibility verification for the exceptions.

If one step is delayed, every downstream activity slows.

For example:

• Incomplete referrals cause authorization delays
•  Incomplete office notes cause payer denials
• Eligibility issues cause resubmission of prior authorizations
• Authorization delays cause scheduling delays
•  Scheduling delays cause reimbursement delays

These are not inconsequential administrative hiccups. They have a direct impact on the Patient Access team, provider productivity, and front-end revenue cycle performance. 

As referral volume increases, the administrative burden on the Patient Access team increases exponentially. 

The more spreadsheets, payer calls, documentation, and status checks that must be completed, the less time your team has to focus on financial clearance and patient readiness. 

The goal is not to merely track prior authorizations in eClinicalWorks. The goal is to reduce the administrative burden of doing so.

Where eClinicalWorks Practices Lose Staff Hours Tracking Prior Authorizations

Most organizations do not struggle with understanding the authorization process

They struggle with the fact that manual processes create unwieldy and time consuming authorization workflows as patient volume, payer requirements, and referral complexity increases

The issue is not the submission of an authorization, but rather what happens after

Every status check, spreadsheet update, documentation request, and payer follow up seems inconsequential on an individual basis. 

Across hundreds of referrals processed per month, however, these tasks combine to steal hundreds of hours from staff that could be spent on scheduling, financial clearance, and patient engagement.

In MGMA’s Annual Regulatory Burden Report, 92% of surveyed medical group practices reported having to hire or reassign staff to handle the increased administrative burden of PA requests, which could have been redirected to care delivery functions like hiring a nurse or increasing hours.

1.  Manual Status Checks Consume Time After Every Submission

After submitting an authorization, staff spend days checking the status of each request.

This often includes:

• Logging into payer portals
• Calling payer representatives
• Reviewing fax confirmations
• Checking clearinghouse status
• Responding to email requests
• Updating spreadsheets

Many organizations find it challenging to track prior auth in eClinicalWorks because authorization updates, referrals, documentation, and payer follow up occur in separate systems outside of a standard Patient Access workflow. 

Each task individually may only take a few minutes, but across hundreds of authorizations processed per month, the combined time spent checking and updating the status of each request adds up to hundreds of hours. 

More importantly, these tasks do not contribute to revenue cycle progression or patient care delivery, they only serve to identify the current status of each authorization.

In MGMA’s Annual Regulatory Burden Report, 60% of respondents said at least three employees are involved in completing a prior authorization request. Additionally, 77 percent of practices said they have hired or redistributed staff to work on prior authorization to the increase in requests.

  2. Referral Tracking Outside the EHR Workflow

As practices grow and referrals become more complex, they often become decoupled from the main referral workflow, with teams tracking requests in:

• Excel spreadsheets
• Shared inboxes
• Sticky notes
• Task lists
• Manual reminders

Without a standard eCW referral workflow, referrals become fragmented across departments, creating challenges for managers trying to answer basic questions about the status of each request.

• Who are the pending referrals?
• Which authorizations are waiting for documentation?
• Which requests are due for renewal?
• Which patients cannot be scheduled due to financial clearance issues?

Rather than focusing on driving the referral through the necessary steps, staff spend time digging through multiple systems trying to find this information.

3. Delays Caused by Documentation Requests

Prior authorization often requires supporting documentation such as:

• Office visit notes
• Diagnostic imaging
• Lab work
• Conservative treatment history
• Medical necessity documentation

If any of these documents are missing, the entire process is delayed as clinical staff pauses to find the records, authorization specialists follow up with payers, and scheduling teams hold appointments.

The authorization request itself may only take a few minutes, but the time spent locating and tracking supporting documentation often outweighs the initial submission.

4. Exception Management Consumes Workflow

Not every authorization request follows the same process. Practices must also navigate additional documentation requests, referral corrections, authorization renewals, benefit verification, peer-to-peer discussions, and appeals.

The challenge is that many Patient Access teams treat every request as an exception, using the same resource intensive manual process for even the most routine authorizations. As the volume of PA requests increases, this method of exception management is unsustainable.

5. Increased Payer Variability

As practices using eClinicalWorks begin to see patients across a wider network of payers, the authorization process becomes more challenging. Every payer has different requirements around documentation, submission, follow up, and response times.

Patient Access teams must navigate commercial payers, Medicare Advantage, Medicaid, and specialty networks, each of which may have different requirements for clinical documentation or follow up.

Some payers only require office notes while others ask for conservative treatment history, diagnostic imaging, or additional medical necessity documentation before approving the request. 

Because these requirements vary by payer, staff spend extra time reviewing payer specific guidelines, collecting additional documentation, checking portals, following up on requests, and responding to additional information needs. 

Within an eClinicalWorks referral workflow, this creates extra administrative work after the initial submission of the authorization. As payer variability increases, standardized Patient Access workflows become essential to reducing unnecessary manual follow up while ensuring each PA request follows the specific requirements of the individual payer.

6. Referral Expiration Creates Additional Administrative Burden

Prior authorization is not the only process with timelines that Patient Access teams must manage. Many referrals also have expiration dates or visit limits that must be renewed or replaced before the patient’s service date.

When a referral expires before services are rendered, additional steps are needed to renew the request, obtain updated documentation, and reschedule the patient’s appointment.

For organizations using eClinicalWorks to track referrals, monitoring both the status of the authorization and the validity of the referral helps reduce unnecessary delays to care while minimizing administrative work for staff.

How Payer Reforms Strengthen the Case for Digital Prior Authorization Workflows

Top payers are trying to ease prior authorization and speed up electronic processing in support of the industry’s digital workflow trend. UnitedHealthcare has eliminated prior authorization requirements for approximately 10% of the prior authorization volume, reducing administrative burden for providers.

Humana  reduces outpatient prior authorization requirements of approximately one-third, and provides decisions within one business day for 95% of complete electronic prior authorization requests.

These reforms underscore the increasing role of digital prior authorization. As payer requirements continue to evolve, eClinicalWorks users can reap the benefits of adopting electronic workflows to reduce manual follow-up, improve authorization visibility, accelerate patient scheduling and minimize front-end revenue leakage. 

“We are committed to reducing prior authorization requirements and making this process faster and more seamless to better support patients, caregivers, physicians, and healthcare organizations.”, said Jim Rechtin, President and CEO of Humana. 

The Hidden Cost of Manual Prior Authorization Follow-Up

Most healthcare organizations understand that prior authorization typically requires administrative follow-up. Far fewer understand what that effort actually costs.

Consider a multi-provider specialty practice with:

• 15 providers
• 40 prior authorizations per provider each week
• Five minutes of manual follow-up per authorization
• Fully loaded labor cost of $35 per hour

The result looks like this:

Based on these assumptions, reducing the time spent on manual prior authorization follow-up by 25% would create capacity for 650 staff hours.

For healthcare executives contemplating a change to front-end operations, recapturing existing capacity can often generate better ROI than trying to increase staffing and operational capacity.

The opportunity cost of operational processes such as manual referrals and prior authorization is much larger than practices realize.

Revenue leakage is often associated with denied claims and delayed payments, but denied claims and delayed reimbursements are merely the final step in a process that usually begins long before the claim is sent to the payer.

When prior authorizations and referrals are handled inefficiently, the downstream impact can include:

• Delayed appointments
• Disrupted provider schedules
• Delays in financial clearance
• Rescheduling of services and procedures
• Claims sent to payers later than necessary
• Administrative staff performing redundant tasks

Inefficient eClinicalWorks prior authorization tracking can also cause prior authorization denials in eCW due to expiring approvals, incomplete referrals, inadequate documentation, or delayed responses from payers

The bottom line is that referral management and prior authorizations should be considered Patient Access workflow quality initiatives, not just administrative tasks.

Healthcare organizations that begin to see the value of improving workflows, optimizing eCW referral management, and reducing labor-intensive follow-up tasks typically find that the benefits go far beyond easing the burden on their staff. 

By creating better schedules, maximizing provider capacity, reducing prior authorization denials in eCW, and protecting front-end revenue, you also improve the patient access experience.

How Accomplished  eClinicalWorks Practices Optimize Referral & Prior Authorization Workflows

The most successful eClinicalWorks organizations focus first on reducing the manual effort required to track referrals and prior authorizations. 

Improving referral and prior authorization performance doesn’t always require additional staff or replacing your EHR. 

In many organizations, the biggest opportunity lies in Patient Access workflow optimization, creating standardized processes where eligibility verification, referrals, documentation, prior authorization, and scheduling work together instead of operating as disconnected tasks.

The goal isn’t to eliminate human involvement. 

It’s to reclaim staff hours currently spent on manual prior authorization follow-up by reducing repetitive administrative work, improving workflow visibility, and allowing Patient Access teams to focus on preparing patients for care rather than tracking paperwork.

How High-Performing eClinicalWorks Practices Optimize Referral & Prior Authorization Workflows

Improving referral and prior authorization performance doesn’t require new hires or alternate EHR solutions. 

For most practices, the opportunity lies in Patient Access workflow optimization, specifically, in establishing standardized referral and authorization protocols that unify eligibility verification, referrals, documentation, prior authorizations, and scheduling into a seamless end-to-end process.

The key is not in eliminating human interaction but in reducing staff workload through minimizing manual follow-ups and enabling Patient Access teams to focus on higher-value tasks.

How to Build a Scalable eCW Referral Workflow

High-performing practices see referral management and prior authorization as an end-to-end workflow, not separate, independent processes.

Each stage has:

• Defined ownership
• Standardized documentation requirements
• Clear workflow visibility
• Measurable performance metrics

Practices minimize the number of steps and opportunities for error while maximizing the ability to track and measure each authorization request throughout its lifecycle.

1. Verify Eligibility Before Initiation of Prior Authorization

Prior authorizations should be initiated only after confirming the patient’s eligibility, benefits, and any referral or prior authorization requirements specific to the insurance plan.

Eligibility verification should confirm:

• Active insurance coverage
• Member benefits
• Referral requirements
• Prior authorization requirements
• Payer-specific policies

Failing to do so often results in incorrect or incomplete submissions, requiring additional time and effort to resubmit or amend the request.

Starting authorization before verifying eligibility often leads to:

• Incorrect payer submissions
• Duplicate work
• Authorization resubmissions
• Delayed approvals
• Additional manual follow-up

Staff Hours Reclaimed: By front-loading the eligibility verification process, you reduce the likelihood of downstream rework and help your team focus on higher-value tasks.

2. Standardize Referral Intake

Inconsistent referral intake leads to delays prior to the start of the authorization process.

Every referral should have a standard set of required elements and supporting documents to avoid interruptions in the workflow due to missing information.

Staff Hours Reclaimed: Following standard intake procedures will help you reduce the time spent on chasing information and managing errors downstream.

3. Replace Manual Tracking with Standardized Work Queues

As practices grow, ad hoc methods such as Excel tracking, email chains, and shared inboxes can no longer support the required level of visibility and responsiveness.

Instead, standardized work queues should be used to provide staff with quick access to the authorizations that require their immediate attention. Managers, in turn, should be able to rely on work queues to assess the overall workload and any potential roadblocks in the workflow.

Staff Hours Reclaimed: Creating standardized work queues helps you eliminate time-consuming spreadsheet management from the day-to-day operations of your Patient Access team.

4. Improve Prior Authorization Status Visibility Throughout the Workflow

One of the biggest challenges in managing a growing eClinicalWorks practice is the lack of end-to-end status visibility for each authorization request.

Without standard operating procedures, Patient Access teams find themselves spending considerable time checking the status of various referrals and authorizations in different systems (payer portals, email, EHR, etc.) instead of focusing on the care coordination and scheduling of the patient.

A properly designed referral and authorization workflow should minimize this type of internal coordination overhead by providing the necessary status visibility at each stage.

A standardized workflow should make it easy to identify:

• Referrals awaiting clinical documentation
• Authorizations pending payer review
• Requests requiring additional information
• Approvals ready for scheduling
• Referrals or authorizations approaching expiration
• Denials requiring follow-up

Staff Hours Reclaimed: By reducing the need to “go digging” for the latest status update inside multiple systems, this upgrade will help you reclaim substantial amounts of time that your Patient Access team currently spends on internal administrative tasks.

5. Focus on Exceptions Within the Authorization Lifecycle

One of the simplest ways to improve the efficiency of the Patient Access team is to stop spending time on activities that offer limited value.

When it comes to prior authorizations, this typically includes routine follow-ups for the status of an authorization. Instead, Patient Access teams should focus their efforts on processing those requests that actually require action, such as:

• Missing documentation
• Peer-to-peer calls
• Payer follow-ups
• Expirations
• Denials &
• Urgent referrals

By shifting the mind-set from “What has been done” to “What needs to be done,” you can significantly increase the productivity of your Patient Access team.

Staff Hours Reclaimed: Instead of manually following up on each authorization, your team will only spend time on those requests that require their intervention, such as resolving exceptions.

6. Specify Ownership of Each Task Within the Authorization Lifecycle

As mentioned above, the end-to-end nature of the authorization process spans across multiple departments and team members.

Depending on the practice, it may be appropriate to delegate responsibility for specific tasks or stages to specific team members, such as scheduling, clinical documentation, payer follow-ups, or denial management.

Staff Hours Reclaimed: By reducing the need for multi-level approvals and minimizing handoffs between different team members, you will significantly reduce the time spent on administrative task coordination.

Building a Scalable Patient Access Workflow for eClinicalWorks Practices 

Not every aspect for managing referrals warrants the same approach

The most efficient practices for Patient Access incorporate standardized workflows, administrative automation, and dedicated operational support, when applicable.

While some healthcare providers seek out referral management software for eCW or want to automate referrals in eClinicalWorks, technology serves as an enabler to standardized workflows, centralized work management, and administrative ownership. 

While the objective is not to automate everything, reducing repetitive administrative tasks and empowering experienced Patient Access professionals to focus on complex payer interactions, documentation, renewals, appeals, and authorization exceptions is paramount. 

Providing dedicated operational support creates capacity for teams to scale eClinicalWorks prior authorization tracking without proportional increases in administrative resources.

What Are The Key Patient Access KPIs eClinicalWorks Workflows?

By reviewing this Patient Access operational dashboard on a monthly basis, executive leaders can determine where issues arise in the workflow before impacting patient access or reimbursements.