Key Takeaways
- Prior authorization software helps small practices reduce manual paperwork, speed up approvals, and prevent delays in patient care.
- EHR integration, automated forms, eligibility checks, and status tracking are essential for simplifying prior authorization workflows.
- Compare PA software based on automation, EHR integration, payer coverage, and pricing.
Prior auth is slowing down your practice. The numbers prove it.
The AMA’s 2024 Prior Authorization Physician Survey found that 94% of doctors say prior auth delays patient care. Staff lose 12 hours per week to paperwork for each physician. And 1 in 4 doctors say a patient has suffered a serious adverse event because of a PA delay.
More staff won’t fix this. Better software will.
This post ranks the top 7 prior authorization software solutions for your small practice. You’ll see what each one does best, and who it's best for. By the end, you’ll know which tool can cut your approval times and get your patients their care faster.
What is Prior Authorization Software?
Prior authorization software is a tool that handles the back-and-forth between your practice and insurance companies before a treatment, test, or medication is approved.
Instead of your front desk calling payers, checking different portals, and faxing forms, the software does the work. It knows which insurers need a PA for which services. It fills in the forms using data from your EHR. It submits the request. Then it tracks the status until you get a yes or a no.
The difference is simple:
- Manual Prior Authorization Software: 20 to 30 minutes per request, lots of phone calls, delayed care.
- Software-driven Prior Authorization: 3 to 5 minutes per request, auto-filled forms, real-time status.
Most tools also plug into your EHR and payer networks, so your team works from one screen instead of six.
7 Best Prior Authorization Software Solutions
Here are the seven prior authorization software solutions for medical practices, compared by features, automation capabilities, pricing, and suitability for different practice needs.
1. PracticeEHR
Best for: Small to mid-sized medical practices that want PA handled inside their EHR.
PracticeEHR is a cloud-based EHR and practice management software that is built for small and independent practices. The PA workflow lives inside the same system you use for charting, scheduling, and billing. That means no second portal, no duplicate data entry, and no extra login.
Key features:
- Built-in eligibility verification for all payers
- PA requirements flagged inside the scheduling screen
- EHR data auto-fills PA forms
- Integrated billing so PA and claims work from one patient record
Pros:
- One vendor, one bill, one support team
- Pricing works for solo practitioners and small groups
- Specialty templates for 25+ specialties
Cons:
- Not a standalone PA tool (you need to be on PracticeEHR)
- Smaller ecosystem than giant RCM-only vendors.
2. CoverMyMeds
Best for: Pharmacy-driven PA, especially for medications.
CoverMyMeds by McKesson owns one of the largest electronic prior authorization networks in the United States. Almost every EHR, pharmacy, and payer is already connected to it. Adoption usually means turning on an existing connection, not installing new software.
Key features:
- Free for providers
- Electronic PA for medications across almost every payer
- Real-time benefits checks at the point of prescribing
Pros:
- Free provider tool
- Fast turnaround on drug PAs (often hours instead of days)
- Massive network reach
Cons:
- Covers pharmacy benefits only (no medical procedures or imaging)
- Limited analytics for practice-level reporting
3. Availity Essentials
Best for: Multi-payer PA at no upfront cost.
Availity connects providers to insurance companies. Its Essentials tier is free and handles basic PA submission across more than 2,000 payers.
Key features:
- Multi-payer PA submission in one portal
- Real-time eligibility and benefits
- Claims submission and remittance tracking
- Standalone portal or EHR integration
Pros:
- Free core tier
- Works across a huge payer network
- Used by over 2 million providers
Cons:
- The free tier is manual-heavy
- Advanced automation requires the paid Essentials Pro tier
- Interface feels dated compared to newer tools
4. Rhyme (formerly PriorAuthNow)
Best for: Scaled medical PA automation.
Rhyme mainly works for medical PAs rather than drug PAs. It uses direct payer integrations to send authorizations from your EHR directly to the payer’s system, cutting out the portal.
Key features:
- Direct payer integrations with major health plans
- EHR-embedded workflow
- Real-time status updates from payer systems
- AI that reads clinical notes to pull the right documentation
Pros:
- Strong on medical PAs (surgeries, imaging, specialty services)
- Good EHR integration
- Measurable turnaround improvements reported by customers
Cons:
- Enterprise-focused, pricing favors larger organizations
- Not as strong on medication PAs
5. Myndshft (now part of DrFirst)
Best for: Specialty practices and diagnostics that need both medical and pharmacy PA.
Myndshft was acquired by DrFirst in 2024. Its platform is one of the few that handles both medical and pharmacy benefit PAs from a single system. That matters in specialty care, where a single treatment may require sign-off from both benefit types.
Key features:
- Combined medical and pharmacy benefit automation
- AI-driven PA requirement detection
- Over 900 payer connections
- Real-time benefits investigation
Pros:
- Rare dual medical + pharmacy capability
- Strong for infusion, oncology, and in-office injectable programs
- Deep benefit verification data
Cons:
- Overkill for primary care practices
- Integration can take longer than lighter tools
6. Infinx
Best for: High-volume imaging, labs, and diagnostics.
Infinx is a PA and RCM platform for diagnostic centers and specialty groups with high PA volumes. It blends automation software with a human services team that handles exceptions the AI can’t close.
Key features:
- AI-driven PA submission
- Combined software plus services model
- Specialty-specific workflows for radiology, cardiology, and labs
- Analytics on denial patterns and turnaround times
Pros:
- Good for practices drowning in PA volume
- The human team handles edge cases the AI can’t
- Strong analytics layer
Cons:
- Service component adds cost
- Not the right fit for a small single-provider office
7. Waystar
Best for: Enterprise RCM with PA inside the same platform.
Waystar sells a full revenue cycle platform. PA is one module inside a bigger system that also handles claims, denials, patient payments, and analytics. Its Hubble engine uses robotic process automation to pull orders from EHRs, decide if a PA is needed, gather documentation, and track the payer’s response.
Key features:
- Authorization Manager module inside the full RCM suite
- Hubble RPA engine for status checks and submissions
- Connects to EHRs, hospital systems, and practice management tools
- Links PA data directly to claim and denial data
Pros:
- One platform for the whole revenue cycle
- Strong for hospitals and health systems
- Deep reporting across the full RCM
Cons:
- Big implementation lift
- Enterprise pricing, not built for solo practices
- You are buying into the whole platform, not just PA
Comparison at a Glance
Before choosing the best prior authorization software for your practice, it is recommended to evaluate your practice needs first. The table below compares the top 7 prior auth software based on practice needs.
| Software | Best for | EHR Integration | Automation Level | HIPAA |
|---|---|---|---|---|
| PracticeEHR | Small/mid practices | Native (built-in) | High + services | Yes |
| CoverMyMeds | Drug PAs | Most EHRs | Medium | Yes |
| Availity Essentials | Multi-payer PA | Portal + EHR | Low (free tier) | Yes |
| Rhyme | Scaled medical PAs | Epic, Cerner, others | High | Yes |
| Myndshft (DrFirst) | Specialty / dual benefit | Major EHRs | High | Yes |
| Infinx | High-volume diagnostics | Major EHRs | High | Yes |
| Waystar | Enterprise RCM | Most EHRs | High | Yes |
Why Prior Authorization Is Broken (And Why Software Fixes It)
Prior auth was supposed to control costs. It became a drag on the whole system. Here is what is actually happening in practices today.
- Staff burnout: The AMA survey found 95% of doctors say prior auth contributes to burnout. Over a third of practices now hire full-time staff just to handle PAs. That is money going to the admin, not care.
- Revenue leakage: A claim is also denied when prior authorization is denied or has expired. MGMA data reports that the cost of reworking a denied claim is roughly $25 per claim on the low end; for a mid-size practice, that adds up to six figures a year.
- Patient drop-off: As per the AMA surveys, 78% of the doctors said they abandoned their recommended treatments for patients because of the prior authorization delays.
- Portal fatigue: A 2026 MGMA Stat poll found that 61% of practices need to log into 7 or more payer portals every week. Staff spend hours just checking status.
A reliable Prior Auth software fixes all issues. It flags what needs pre-fill, what is already in the chart, and keeps all requests visible on a single dashboard. Your team stops hunting and starts treating.
For a deeper look at how PA ties into your overall revenue cycle, see our guide on denial management in medical billing.
7 Must-Have Features in Prior Authorization Software
Before you pick a vendor, know what to look for. Here is the buyer’s checklist.
- Real-time eligibility verification: The software should check a patient’s insurance coverage before anyone touches a PA form. Without this, your team is flying blind.
- Payer rule library: A built-in database that tells you which services need a PA for which plan. It should update automatically as payer rules change.
- EHR integration: This is an important one. If the PA tool can’t pull data from your EHR automatically, your staff would have to copy data from the systems, leading to a high chance of manual errors. Ask for direct integration with your specific EHR, not just “API-ready” marketing speak.
- Auto-filled forms: The software should fill PA forms with patient demographics, diagnosis codes, clinical notes, and attachments from your EHR. No retyping.
- Status tracking dashboard: One screen that shows all open PAs, their status, and their deadlines. No portal-hopping.
- Analytics and reporting: Which payers deny the most requests? Which staff member resolves PAs fastest? Which services cause the biggest backlog? Good software answers all these.
- HIPAA-compliant architecture: Encryption at rest, encryption in transit, audit logs, access controls, and a signed BAA from the vendor are all non-negotiables.
If a vendor can’t check all seven boxes, keep looking.
For more on eligibility, see our eligibility verification guide. For how PA fits into the bigger RCM picture, read our Revenue Cycle Management software guide.
How to Choose the Right Prior Authorization Software for Your Practice
The “best” tool depends on your setup. Four things matter most.
1. Practice size
- Solo or small group: PracticeEHR, CoverMyMeds, Availity
- Mid-sized group (5 to 25 providers): PracticeEHR, Rhyme, Myndshft
- Large group or hospital: Waystar, Rhyme, Infinx
2. Specialty
- Primary care: PracticeEHR, CoverMyMeds
- Specialty (oncology, infusion, imaging): Myndshft, Infinx, Rhyme
- Multi-specialty groups: PracticeEHR, Rhyme
3. Budget
- No budget for new software: Availity Essentials, CoverMyMeds
- Moderate budget: PracticeEHR
- Enterprise budget: Waystar, Infinx, Rhyme
4. Your current EHR
- If you already use PracticeEHR, PA is built in.
- If you use Epic or Cerner, Rhyme and Myndshft integrate well.
- If you are on multiple systems, Waystar can tie it together.
A quick rule: if your PA workflow takes less than 10 minutes a day, you probably don’t need a new tool. If it is eating hours, you do.
The Future of Prior Authorization: CMS Final Rule and AI
Prior auth is about to change. Two big shifts are coming.
1. The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F)
In January 2024, CMS finalized a rule requiring many payers to expedite PA decisions and share data electronically. The major compliance dates:
- January 1, 2026: Payers must publicly report PA metrics.
- January 1, 2027: Payers must offer a FHIR-based Prior Authorization API, respond to urgent PAs within 72 hours and standard PAs within 7 days, and include a reason for every denial.
The rule covers Medicare Advantage, Medicaid, CHIP, and some ACA plans. Private commercial plans are not covered yet, but most will be covered eventually.
2. AI-driven predictive PA
New tools use AI to predict whether a PA is needed before you order the service. They scan the patient’s chart, the plan’s rules, and recent payer behavior to flag likely approval or denial in seconds.
3. Gold carding
Some states and payers now offer “gold card” programs. If a provider’s PA approval rate stays above a set threshold (often 90%), they get exempted from PA for certain services. Texas, Michigan, Vermont, and a handful of other states have passed gold carding laws.
If you are buying PA software today, ask the vendor if their roadmap includes FHIR support and AI-based pre-check. If they can’t answer, they are already behind.
Explore More: What Other EHR Features Can Optimize Practice Efficiency of Small Practices
Simplify Prior Authorization with PracticeEHR
Prior auth isn’t going away. But the 12 hours a week your team spends on it should.
The right software cuts that time, lowers denials, and keeps your patients from walking away before treatment starts. Which tool fits depends on your size, specialty, and budget.
Want PA handled inside the same system you use for charting and billing? Book a free demo and see how PracticeEHR works end-to-end.
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