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Challenge: Manual authorizations couldn’t scale with demand
Manual workflows were no match for MetroHealth’s growing prior authorization demands. With more than 300,000 patients coming through the doors each year, staff at the MetroHealth system spent their days manually chasing requests and approvals through phone calls and payer portals.
Without a reliable way to track approvals, denied authorizations were often discovered late, forcing staff to scramble for status updates. Teams were overwhelmed, appointments were pushed back and patients waited longer for the procedures they needed.
As the workload grew, so did the risk of claim denials, leaving the organization to absorb preventable revenue loss alongside hefty administrative costs. MetroHealth needed a way to scale authorizations without adding more strain to its teams.
Solution: Authorizations that run in the background, not on the phones
Hiring was off the table, so MetroHealth sought a revenue cycle management partner that could handle their authorization volumes and reduce reliance on manual, time-consuming processes. Ideally, this would be a vendor with strong payer connections and proven automation technology. Experian Health met those needs with its Authorizations solution.
Authorizations automates inquiry and submission, so staff don’t have to drop what they’re doing to move a request forward. When a physician places an order in Epic, the authorization process starts immediately. Automation captures payer details and submits the request in seconds, while posting real-time updates into the electronic health record. It only asks for input when needed, guiding users through dynamic work queues to focus their time on what matters. The system also communicates directly with connected payers, and staff gain visibility into the status of each authorization.
A big draw was Experian Health’s extensive connections with major payers and utilization management companies, including UnitedHealthcare, Aetna, Humana, Cigna, eviCore, AIM and NIA. Whatever the specialty, Authorizations routes requests to the correct payer partner, helping speed determinations and keep care on schedule. This enables MetroHealth to process a wide range of authorization types through a single workflow, eliminating the need to handle requests in separate channels.
MetroHealth also benefits from Authorizations’ Knowledgebase feature. Rather than guessing which procedures require authorization, staff can refer to a continually updated library of payer rule sets that Experian Health updates monthly. Custom rules can be added whenever an unusual requirement pops up. This gives the health system greater control and helps ensure requests are accurate the first time.
Outcome: From firefighting authorizations to a predictable routine
Here are a few wins from MetroHealth after they implemented Experian Health’s Authorizations solution:
- Monthly authorization transactions increased by 173%, from 2,200 to 6,000.
- Teams now work 30 days ahead of scheduled services instead of just 14, an increase in 114% time available.
- Average time spent on each authorization request dropped from 10 minutes to just under 4 minutes.
- Follow-ups are 50% faster.
- Peer-to-peer reviews happen 4–5 days sooner.
One of the biggest improvements was simply being able to take on more work. An authorization request that used to take around ten minutes now takes just under four, and follow-ups move 50% faster because status checks run in the background. Instead of spending their day retyping information or digging through portals, staff can focus on exceptions and cases that need more attention.
The team is no longer constrained to a tight two-week window and can initiate authorizations 30 days before the scheduled service. Doubling the lead time in this way gives them some breathing space to manage cases proactively, rather than reacting at the last minute, and helps prevent denials and delays.
Thanks to this extra capacity, the same team went from handling roughly 2,200 authorizations per month to about 6,000, allowing MetroHealth to support more service lines and higher patient volumes without hiring more staff. They can rely on the system to capture the required details and keep requests moving.
On the clinical side, a 60% decrease in time spent on authorizations and faster peer-to-peer reviews means patients receive decisions sooner. Good news, too, for busy clinicians already working full schedules.
How MetroHealth made authorizations manageable
MetroHealth’s experience shows that authorizations don’t improve by squeezing more effort out of staff, but by creating time and capacity for teams to work efficiently. For the management team, progress came down to three things:
- Bringing the right people in from the start, so everyone was aligned on the workflow and goals.
- Making data easy to find, such as building CPT codes into the system instead of burying them in spreadsheets or printouts.
- Investing in training and ongoing communication so teams knew how to use the solution and could get the most from it.
Learn more about how Experian Health’s Authorizations solution helps reduce manual effort and keep care and cash flow on track.
