Unite AI innovation and R1 expertise to elevate clearance and slash denial rates
Prior authorization is one of healthcare’s most significant administrative burdens, costing the industry an estimated $35 billion annually and causing 92% of care delays. As providers face growing pressure to move faster, lower costs and modernize authorization workflows – particularly in the face of regulatory changes like the Prior Authorization Final Rule and WISeR – those providers need a scalable solution that clears authorizations more quickly and reduces auth-related denials.
R1, the leader in healthcare revenue management, recently announced the launch of R1 Prior Authorization, a comprehensive solution designed to automate and streamline the prior authorization process at scale.
Results providers can measure
Built on years of operational experience and powered by the Phare Operating System™, R1 Prior Authorization clears 68% of all orders in one hour and nearly 97% in one day, with an average auth-related denial rate of less than 1%. Providers see faster approvals, lower costs and improved access to care for their patients – outcomes that are difficult to achieve with traditional approaches and labor-intensive solutions.
Today, R1 processes approximately 39 million orders annually and has more than 1,600 dedicated experts who ensure accuracy and accountability. For providers, this means meaningful cost reduction in an industry where the average cost of prior authorization ranges from $35 to $50 each.
Smart solutions at scale
Powered by Phare Access – the smart patient access hub of R1’s Phare Operating System – R1 Prior Authorization manages the full authorization lifecycle through a comprehensive three-step process: determination, submission and completion.
The solution intelligently identifies when an authorization is required, submits complete requests with the right documentation, and proactively tracks decisions, updating the decision in the patient’s EHR. This three-step model applies real-time payer intelligence and automation at scale, with expert oversight where needed. This proven approach improves timely access to care for patients across inpatient and outpatient service lines, with all payers in scope.
With R1 Prior Authorization, customers can expect:
- A comprehensive, yet simplified, approach. From determination to completion, R1 handles every aspect of the process.
- Always-current payer intelligence. An always-current rules engine and deep payer connectivity keep up to date with payer policy changes and ensures all payers are in scope.
- Automation at scale. R1 ensures faster processing with fewer errors by automating processes like digital order submission, coverage verification, determination and proactive status tracking.
- Human-in-the-loop oversight. More than 1,600 authorization experts assure quality to guarantee that no orders fall through the cracks.
- Quality without the price tag. Providers gain transparency into authorization costs and can reduce total spend by up to 50% compared to traditional approaches.
“R1 Prior Authorization sets a new standard, delivering the first zero-touch solution that enables secure, real-time automation at scale,” said Steve Albert, chief product officer of R1. “With the growing need for real-time payer decisions, the burden of prior authorization has become a strategic focus for providers, payers and policymakers – fueling demand for solutions that automate and streamline workflows.”
“Partnering with R1 to modernize prior authorization has transformed the speed at which we can move patients into care,” said the Executive Director, Patient Access, at a Florida health system with over $700M in NPR. “With R1’s automated, rules-based workflows, we’ve significantly reduced our system’s administrative burden, improved scheduling efficiency and reduced unnecessary friction for patients and referring providers. Today, more than 99% of our prior authorizations are cleared within three days, driving measurable gains across our revenue cycle and improved patient and provider satisfaction.”
