Forty-five minutes to three seconds

The 2024 AMA Prior Authorization Physician Survey, fielded across 1,000 practicing physicians, found that practices complete an average of 39 prior authorization requests per physician per week and spend 13 hours weekly on the process. 40% of physicians employ staff who work exclusively on prior auth. 93% report PA delays patient care.¹ The CAQH 2024 Index estimates manual prior authorizations cost approximately $3.41 per transaction electronically — and quantifies the time savings at 14 minutes per transaction when fully automated.²

For ASCs specifically, the financial stakes are higher than for office-based practices. Surgery center RCM analyses widely cite that approximately two-thirds of ASC claim denials stem from authorization issues.³ Each one of those denials is a case that may have already happened — meaning the surgeon billed, the implant was used, the staff was paid, and the payment now has to be fought for.

KFF analysis released January 28, 2026 found that Medicare Advantage insurers issued 52.8 million prior authorization determinations in 2024 — more than 90% fully favorable, but the volume itself signals how heavily payers lean on PA as a utilization-management lever.⁴

Three things make orthopedic and high-acuity ASC prior auth particularly hard. The result is an authorization process that's slow, error-prone, and inconsistent — and a denial process that's the same. MGMA cites Health Affairs estimates that prior authorization burden costs the U.S. healthcare system $23–31 billion annually.⁶

Lily's Prior Authorization agent doesn't just submit a form. She reads the chart, runs medical-necessity logic against the actual evidence base, and drafts a complete authorization letter with citations — typically in about three seconds compared with roughly 45 minutes manually.⁶ For a given case, Lily:

1. Identifies the payer-specific requirements for the CPT codes being requested, drawing on a maintained library of commercial, Medicare, and Medicaid policies.
2. Reads the chart to find the conservative care documentation, imaging findings, functional status, and clinical history.
3. Compares the documented evidence against AAOS clinical practice guidelines and InterQual criteria.⁵
4. Drafts the authorization letter with verbatim citations to the relevant criteria.
5. Surfaces gaps when the chart doesn't fully support the request — so the surgeon's office can fix the documentation problem before submission rather than after a denial.

The human reviewer approves, edits, or rejects. The submission goes out clean. The audit trail is complete.

Two things change, mostly. First, the auth gets done on the day the case is scheduled, not the day before the case is supposed to happen — which collapses the cancellation risk that comes from approvals arriving late. Second, the people who used to do prior auth all day get to do something else. AMN Healthcare's March 2025 Healthcare Leadership Trends survey found 46% of healthcare leaders plan to leave their organizations within the next year — with 26% saying they would do so either immediately or within the next six months.⁷ Getting administrative work off your most experienced staff isn't a nice-to-have. It's a retention strategy.

Federal regulation is also pulling in this direction. CMS-0057-F, finalized in January 2024, requires payers to send PA decisions within 72 hours for expedited requests and 7 calendar days for standard requests beginning January 1, 2026, with public PA metrics due March 31, 2026 and FHIR-based Prior Authorization APIs live by January 1, 2027.⁸ ASCs whose front-end systems can already produce structured, well-cited PA submissions will get the most out of those APIs the moment payers go live.