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Prior Authorization

Faster approvals

R1 Prior Authorization combines AI-powered technology with trusted experts to manage authorization from start to finish.

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R1 delivers unmatched speed, accuracy and scale that standalone options can’t deliver. Our proprietary approach reduces costs, accelerates approvals and protects revenue.

68%

orders cleared in 1 hour

96%

orders cleared in 1 day

1%

auth-related denial rate

39M

orders processed annually

Features

Handle prior authorizations from start to finish

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Process initiation

Automated intelligence prioritizes orders instantly, verifies coverage and identifies authorization needs, preventing delays.
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Quality submissions

Connect directly with payer systems to submit complete requests aligned with the latest rules and optimal auth channels.
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Strategic intelligence

When authorization gaps arise, R1 experts step in to resolve issues, ensuring complex cases reach approval without stalling.
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Real-time tracking

Continuous monitoring through completion informs teams and ensures patients move into treatment, reducing rescheduling.

A fully managed prior authorization solution that combines automation, real-time payer intelligence and expert oversight to reduce administrative burden, accelerate care and improve financial performance.

Prior Authorizations
Workflow + process
Traditional
Fax, phone, payer portals or semi-automated but still requires provider FTEs
R1’s AI-assisted Prior Auth engine
Full auth process from determination to submission and follow up with human-in-the-loop when needed
Service line support
Traditional
Typically limited to more straightforward service lines like radiology and imaging
R1’s AI-assisted Prior Auth engine
Ability to support both outpatient/inpatient and always evaluating new service lines to add
Labor intensity
Traditional
High FTE hours; dedicated staff required. OR reduced staff needs but still requires oversight
R1’s AI-assisted Prior Auth engine
Zero burden on provider staff
Integration
Traditional
Limited EHR and payer integration or manual entry required
R1’s AI-assisted Prior Auth engine
100% payer coverage, no matter how big or small
Final auth-related denial rate
Traditional
~3-5%
R1’s AI-assisted Prior Auth engine
<1%
Turnaround time
Traditional
Hours to days or even weeks if in-house
R1’s AI-assisted Prior Auth engine
68% cleared < 1 hour; 96% cleared < 1 day
Accuracy + success
Traditional
Moderate; vendor-assisted checks
R1’s AI-assisted Prior Auth engine
High first-pass approvals
Case Study

Baptist Health Care Clears 99% of Authorizations Within 3 Days

By centralizing, standardizing and automating prior authorizations, Baptist realized measurable gains across the revenue cycle, scheduling and provider engagement. Learn how R1 helped.

Read the case study
A man and a woman are working together in an office setting. The man is seated at a desk, looking at a computer screen, while the woman stands beside him, pointing at the screen. Both appear focused and engaged in their work. The office is well-lit and there are large windows in the background.

Deliver a seamless, AI-driven patient access experience that clears patients early, reduces errors and improves financial performance across the revenue cycle.

Phare access

Part of Phare Access

Phare Access blends AI and intuitive tools to clear patients early, verifying insurance, securing authorizations and embedding accurate patient data at intake. Minimize errors, maximize collections, fill schedules and create a seamless experience for both patients and staff.

Explore

A connected suite of pre-service solutions designed to simplify patient access and accelerate care.

( 1 )

Scheduling Optimization

R1 Scheduling Optimization turns stalled orders into scheduled visits to keep patient care on track.
SOLUTION OVERVIEW
( 2 )

Pre-service Peer-to-peer

R1 Pre-service Peer-to-peer reviews support medical necessity, getting authorizations and resolving disputes quickly.
SOLUTION OVERVIEW

Meet our experts

Subject Matter Experts

ron kwak

Ron Kwak

GM, Patient Experience
tom lytle

Tom Lytle

SVP, Operations, Digital Transformation & Experience

Solution

Learn more about how R1 Prior Authorization can speed up both care and payments.

Professional analyzing data visualizations and digital patterns, representing AI-driven insights and advanced analytics.

Solution overview

Find out how R1 Prior Authorization can clear authorizations quickly, improving the patient experience while minimizing denials and improving payment times.

Learn more

Resources

Latest trends and expert analysis

R1 Prior Authorization
News

R1 Prior Authorization, Now Powered by the Phare OS, Accelerates Care, Reduces Costs and Improves Accuracy
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Start clearing authorizations faster. Contact us for an assessment.

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