Multispecialty practices operate on the basis of distinct payer policies for different departments, which results in discrepancies between workflows, varying rates of complexity across specialties, and the coordination of the supplemental use of the different departments’ workflows. Understanding the most common multispecialty prior authorization roadblocks can enable clinics to facilitate more efficient use of resources for practices while remaining compliant in 2026, especially with evolving requirements under the 2026 CMS Physician Fee Schedule.
Roadblock 1: Variance in Workflow for Each Specialty
The greatest challenge for multi-specialty practices is that every specialty has its way of handling prior authorizations. This results in an increased level of confusion and delays, the most common reasons for authorizations not being approved.
Solution: Create an authorization process that is uniform to every specialty and also allows for specialty-specific additions and modifications. Establish common intake checklists for any specialty and develop a single tracking system. This allows for consistency in processes while still providing each specialty with the ability to be adaptable to their unique requirements.
Roadblock 2: Lack of Visibility of Authorization Status of Pending Requests
With numerous departments involved in processing prior authorization requests, there may be a lack of clarity regarding where requests are in the authorization process. Many times, requests stand idle due to no department realizing that the authorization is still pending or incomplete.
Solution: Centralize authorization information for pending authorizations by integrating all specialties into one system. Team members evaluate the pending authorization request for potential cancellation on a daily basis. This visibility also improves downstream multispecialty billing accuracy by ensuring that only properly authorized services move forward to claims.
Roadblock 3: Gaps in Documentation between Specialties
Specialty documentation practices differ, and the payers expect equal documentation and justification of medical necessity for every level of care, no matter what specialty services are requested.
Solution: Create payer-based documentation guidelines and specialty-based templates, train staff to recognize the most common reasons for denial of authorizations.
Roadblock 4: Communication Breakdown Between Clinical and Administrative Staff
Communication problems arise in multi-specialty practices as a result of disconnects between clinical and administrative staff. The clinical staff will not know if there is a documentation delay if the administrative staff does not communicate that the delay is due to an action taken by the administrative staff, nor whether the administrative staff should take action to expedite processing.
Solution: Establish clear communication channels between all clinical departments and staff, as this will improve the efficiency and effectiveness of the authorization process.
Roadblock 5: Authorization Volume Exceeds Staffing Capacity
As the number of required authorizations for patient care increases, it becomes difficult for internal teams to keep up with the volume of requests that must be processed. This results in burnout, missed deadlines, and increased rates of denial.
Solution: For organizations experiencing high volumes of authorizations, consider implementing alternative support options such as outsourced prior authorization services for multispecialty practices. By using the expertise of trained staff across the continuum of treatment, during periods of heavy workload, you maintain the same level of authorization consistency that you would experience during peak periods.
Improving Workflow Efficiency With Expert PA Support
With the increased complexity of multispecialty PA services being rendered by practices, many providers are making the strategic decision to outsource the prior authorization process, thus allowing for greater efficiency in their organization. In many cases, the best option for providers is to partner with RCM Workshop to provide outsourcing for their multispecialty prior authorization process to scale and allow for consistency while providing patient care.
