careviso releases comprehensive 2024 audit uncovering ongoing administrative burden of prior authorizations in diagnostic testing
careviso released the findings of its extensive 2024 audit, offering a significant look at the continued complexity, delays, and inefficiencies in the PA process across the U.S. diagnostic ecosystem.
With just under one million prior authorization requests analyzed, careviso’s audit highlights what clinicians and patients alike have long known: while prior authorization was designed to ensure appropriate use of services and manage healthcare costs, its implementation today often introduces administrative hurdles that can delay care and increase provider burden.
careviso’s 2024 audit paints a clear picture of operational friction within the healthcare system. While many cases moved efficiently through the system, challenges remained. Just over three-quarters of all cases resulted in either an approval or were determined not to require prior authorization, demonstrating the value of precise documentation and payor connectivity. However, approximately one-quarter were denied, and a notable portion required administrative follow-up before a decision could be rendered-adding complexity and delay to already time-sensitive clinical workflows.
The audit also found that most cases were resolved in an average of 5.5 days —time that, while faster than industry norms, can still translate to delayed patient treatment, rescheduled appointments, and administrative stress on care teams.
Among the most frequently cited denial reasons:
- Services were not provided or authorized by network providers (Codes 242 & 243)
- Information from the rendering provider was missing or incomplete (Code 226)
- Procedures were deemed investigational or not covered by benefit plans (Codes 55 & 204)
These denials reflect a broader reality: even when care is appropriate, authorization can be denied due to data gaps, benefit limitations, or payer policies—resulting in cascading effects for providers and patients alike.
careviso’s April 2025 survey of 2,500 U.S. patients found that 81% reported PA requirements had delayed or disrupted their access to care.
