If you’ve ever felt frustrated by the slow, confusing process of getting treatments approved through prior authorization, you’re not alone. Many providers face delays, resubmissions, and long hours of back-and-forth communication just to get approval for services their patients clearly need. 

 

But here’s the good news: change is finally coming. 

 

On Monday, federal health officials announced that major improvements to the prior authorization process are on the way. These changes are meant to make approvals faster, clearer, and less stressful—for both healthcare providers and patients. But like any big change, this transition won’t happen overnight. And for clinics, hospitals, and provider groups, the question is simple: 

 

Is your team ready to make the shift? 

 

What’s Changing with Prior Authorization? 

The Centers for Medicare & Medicaid Services (CMS), along with many private insurers, have agreed to overhaul the prior authorization system. Their goal is to reduce paperwork, improve response times, and make the entire process more transparent. 

 

Here are a few key changes coming soon: 

 

Faster Approvals 

Insurers are pledging to respond to prior authorization requests more quickly. Some services will even be approved in real time by 2027. 

 

Fewer Services Requiring Prior Auth 

By January 2026, insurers plan to reduce the number of treatments and procedures that require prior authorization. 

 

Approvals That Carry Over 

If a patient switches insurance plans mid-treatment, the new insurer will be expected to honor prior approvals for at least 90 days. This avoids treatment interruptions due to paperwork. 

 

Clearer Denial Explanations 

When a request is denied, providers will receive a clear explanation of why it was rejected—and how to appeal. 

 

Why Prior Authorization Changing Matters to Your Team

Prior authorization changing is a step in the right direction—but it also comes with a transition period, and that’s where the real challenge lies. New platforms, new timelines, and new rules mean your current workflows may need to be updated. Your team might need to learn new systems, adopt new tools, or shift responsibilities. And depending on your practice size and staffing, this could either be a smooth transition—or a stressful one.

Here’s why preparing now will help you stay ahead:

Technology Will Play a Bigger Role

One of the biggest shifts in prior authorization changing is the move away from manual submissions (like fax or phone calls) toward real-time digital platforms. While this will eventually save time, it also means your team needs to get comfortable with new tools and processes.

If your staff is still relying on outdated methods, it’s time to assess where improvements can be made. Look into whether your EHR system can integrate with upcoming prior auth platforms, and consider remote staffing or training support for the transition.

Staff May Need Support or Upskilling

Navigating both old and new systems at the same time can be overwhelming. During this transition period, your team will likely face a learning curve—especially if they’re expected to understand new submission rules, documentation standards, or insurance portal updates.

Rather than overloading your in-house staff, many providers are turning to remote support teams who are trained to handle both traditional and evolving processes under prior authorization changing rules. A skilled transition partner, like MedCore Solutions, can provide flexible staffing and training solutions during this critical time.

Patients Will Still Rely on You for Answers

Even if insurers promise a smoother process, patients may still experience confusion—especially during insurance changes, appeals, or coverage gaps. Your front desk or admin team will still be the first point of contact when questions arise.

That’s why documentation, communication, and clarity matter more than ever. As part of your transition plan, make sure your team knows how to explain next steps to patients clearly and kindly—especially in cases of denial or delay related to prior authorization changing.

 

How to Prepare for the Changing Prior Authorization Landscape

As prior authorization changing takes effect across the industry, it’s important to ensure your clinic or organization is prepared. Here are a few simple steps to get ahead of the curve:

Audit Your Current PA Workflow

• How long does it take to get approvals?

• How many are delayed or denied?

• Are you still using mostly manual methods?

 

Understanding your baseline will make it easier to identify areas that need updates as prior authorization changing becomes the new standard.

Train Staff on Digital Submissions

• Familiarize your team with real-time submission platforms (if available)

• Practice submitting documentation with the right level of detail

• Review how to handle denials and appeals effectively

 

Preparing now ensures your team isn’t scrambling later when new systems and timelines tied to prior authorization changing go into effect.

Update Internal Checklists

• Revise your prior auth checklist based on new insurer guidelines

• Add templates for appeals and documentation

• Share updated resources with everyone involved in the process

Partner with a Transition Support Team

MedCore Solutions can provide remote staff trained in both current and upcoming requirements under prior authorization changing policies. We help reduce the burden on your in-house team while ensuring accuracy, speed, and compliance.

 

Why MedCore Solutions Can Help 

At MedCore Solutions, we understand that prior authorization isn’t just paperwork—it’s a vital part of keeping care moving. And during times of change, having the right support makes all the difference. 

 

Our remote staffing solutions are built specifically for healthcare providers. Whether you need help managing approvals, improving documentation, or training your current staff, our team is ready to support your transition. 

 

We’ve already helped clinics across the country reduce delays, handle denials, and prepare for the next phase of prior authorization. Let us help you do the same. 

 

Final Thoughts 

Big changes are on the horizon for prior authorization. While the long-term outlook is promising, the transition period will take planning, patience, and the right support. By getting ahead of the shift now, your practice can avoid delays, keep patients happy, and stay focused on what matters most—delivering great care. 

 

Ready to make the transition smoother?

Let’s talk about how MedCore can support your team through the changes ahead. Contact us here.