Ep. 49 - Effective Strategies for Prior Authorization + Eligibility Verification

In this episode of For the Love of Revenue Cycle, Vanessa breaks down why prior authorization and eligibility verification are two of the biggest drivers of preventable denials — and how getting them right is essential to clean claims and healthy cash flow. The discussion covers the foundations of payer requirements, the difference between denials and rejections, and where most revenue leakage actually occurs across the front end of the revenue cycle. Vanessa shares practical best practices for improving accuracy and efficiency in PA and EBV workflows, along with real industry data on denial trends. The episode also explores how modern technology, including agentic AI, is transforming these processes by reducing manual work, closing operational gaps, and shifting organizations from denial resolution to true prevention. 00:00 Welcome and Introduction 03:07 Understanding Clean Claims 06:04 Claim Requirements Explained 10:41 Denials vs Rejections 12:25 Why Prevention Matters 17:05 Front End vs Backend 22:05 Prior Authorization Deep Dive 26:28 PA Process Step by Step 29:34 Prior Authorization Best Practices 32:15 Eligibility and Benefit Verification 35:55 EBV Best Practices 38:52 Technology and AI Overview 42:30 Understanding Agentic AI 44:48 AI in PA and EBV Workflows 48:04 Closing and Call to Action