The payer’s portal wants a six-digit code, and the code is on its way to the biller’s phone. She’s out until Wednesday.
A patient stands at the front desk, waiting to hear whether a prior auth went through. A medical assistant works down the shared password sheet, two years old by now, until the login locks on the third try. The patient leaves without an answer, and the visit stays unbooked.
At five, the physician asks the office manager what happened. The question goes on tomorrow’s list under her name. That was one payer. Now multiply it by every plan you bill.
If your biller were out tomorrow, who else could get into your largest payer’s portal and finish an auth without a call to her cell? If the honest answer is a pause and then a single name, the work waits on one person’s calendar, and the person covering for her is doing two jobs at once.
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That afternoon was settled weeks earlier, when no one decided who signs in to the payer sites.
Six in ten polled practices use seven or more payer portals
How many payer portals does your staff open in a typical week? The Medical Group Management Association (MGMA) asked medical practices about portal counts in March 2026. Of the 252 responses, 10 percent said three or fewer, 29 percent said four to six, 35 percent said seven to ten, and 26 percent said eleven or more.
Now count the people next to those portals. Suppose your staff opens eight, and six people in your office touch insurance work. That’s up to forty-eight combinations of a person and a login, and any one of them can be the one that locks on the day it’s needed. One patient’s prior auth can start with an eligibility check at the front desk and end as a denial on the biller’s desk, with a medical assistant’s clinical note somewhere in between. Someone has to keep that list straight.
Authorization trouble reaches the patient first and the revenue next
Leave the logins unassigned for another year and a patient’s second call to the front desk would stop being unusual. A physician would spend part of the day on hold, and the patient would eventually stop calling back.
The 2025 American Medical Association (AMA) survey of 1,000 physicians measures prior authorization overall, so read it as the general cost of a stalled auth. Seventy-nine percent reported that patients abandon treatment because of authorization challenges, and 26 percent reported a serious adverse event tied to prior authorization. For your own practice, pull last month’s list: How many auths sat open because no one on staff could sign in?
Some payers are on a set clock now, too. Since January 1, 2026, Medicare Advantage plans and Medicaid and Children’s Health Insurance Program (CHIP) programs and plans have had to answer standard prior authorization requests within 7 calendar days and expedited ones within 72 hours. That clock starts only when someone gets the request filed.
The revenue side is harder to see. Kodiak Solutions, a health care analytics company, reported that 11.81 percent of claims were denied on first submission in 2024, across more than 2,100 hospitals and 300,000 physicians, so a practice’s own rate may run higher or lower. That rate covers all claims, including ones with no authorization involved, and a denial worth chasing becomes an appeal. MGMA says auth and appeal workflows still frequently send staff back to individual payer portals.
Cross-training and clearinghouses solve only part of the job
You’ve probably tried the obvious answer already: Cross-train the front office so anyone can cover anyone. Suppose the biller is out for two weeks and a cross-trained front-desk employee steps in. She knows the practice’s workflow, and she sat through a walkthrough of that payer’s site once, last spring. Then the site logs her out mid-request, or rejects a referral number she typed into a field that looked optional, and the front desk runs a person short while she sorts it out.
MGMA’s advice points toward specialization: Assign portal-specific responsibilities so each person builds deep fluency with fewer portals. A clearinghouse covers part of it. MGMA says these tools can meaningfully reduce direct portal logins, mainly for eligibility and claim status. After the 2024 Change Healthcare outage, some practices shifted work back to individual payer portals, and the problem has lingered.
A named pair covers one plan but strains a small office
Draw a grid with your staff down the side and your payers across the top. Mark every box where a person has a working login, then circle the one or two you’d ask if that payer’s portal locked someone out. A column with a single mark is your first gap.
Start with your largest payer and name a primary and a backup, so that when the code goes to one phone, the other can still sign in. If the month goes well, the same pair can take two more. Ask the payer how a second person can get verification codes and what its access terms say about shared credentials.
The pair writes one page covering the lockouts and the fields that trip people up, and one of them keeps it current and dates each change. Anything that needs a payer site then routes to the pair, so the front desk and the medical assistants send a message instead of opening the site. After a month, check whether the same two people handled the work and whether anyone used the page.
Here’s what that costs. Two people have to learn every portal on top of their own jobs, and auths and denials keep arriving on the payer’s schedule, whatever the pair’s free hours look like. In a three-person office, the pair is most of the staff.
The work needs dedicated owners, each with a backup
The American Academy of Family Physicians says it in one line of its prior authorization guidance: “Designate one or more dedicated staff to submit prior authorizations.” The AMA’s 2025 survey found that two in five physicians already employ staff dedicated exclusively to prior authorization tasks. The backup is our addition, because the scene at the front desk shows what one name with no cover looks like. MGMA’s fluency point, above, fits owners in the plural.
Size the work before you decide. The AMA survey found that prior authorization consumes an average of 13 hours of physician and staff time each week, with physicians completing an average of 40 prior authorizations a week. Your own number will differ, so count last week’s hours, yours and your staff’s.
Then price the staff hours. Employer costs for private-industry office and administrative support workers were $35.96 an hour in December 2025, with $24.79 of that in wages. Any physician hours in your count cost more. For scale, a full-time seat at that rate, 2,080 hours a year, comes to about $74,800. If your staff hours come to a fraction of a seat, hiring two people to cover them is the wrong shape for the work, and, in our view, owners shared across practices fit better. If they come to a full seat or more, the case for dedicated owners gets stronger.
The decision starts with one question. Can two of your own people absorb that? If they can, you’re approving a month of their time, one page, and a routing rule, and the front desk stops opening that site. If they can’t, the work still needs two things: owners whose main job is payer work, and a backup behind each of them for the weeks they’re out.
A single hire leaves a gap that an outside team can close
A single hire gives you one owner and no cover, because the day that person is out, the locked portal and the waiting patient are back. Two part-time hires would mean two recruiting rounds and two absences to cover. Hiring adds its own problem: In an October 2024 MGMA poll with 427 responses, 53 percent of medical group leaders named finding candidates as their top staffing challenge.
A well-run outside team can supply both roles, because more than one person is on your account, so an absence moves the work to someone who already knows the payer, and keeping those seats filled is the team’s job. It has a cost of its own: Someone in your office still has to explain your payers and workflows at the start, and you give up some day-to-day say over who does what. It also only holds if one team covers the whole chain, from checking coverage through the prior auth to the denial. A service that only works claims leaves the first two links with you.
Before it touches a login, you’ll want to know who on its side signs in to each payer, where the verification codes go, and who steps in when that person is out. Ask whether it signs a business associate agreement (BAA) and how access is taken back. Get the answers in writing and compare the monthly price to the seat figure above. Then start with one payer for a month, the way you’d run your own pair.
Ask any team, inside or outside your office, the question this piece began with: When the person who signs in to your largest payer is out, who does?
Karan Kanwar is the CEO of Central AI and Wing Assistant. Central AI provides an AI operating system for appointment-driven medical practices, handling calls, texts, web chat, and messages around the clock, qualifying patients and booking appointments directly into a practice’s existing systems. It is HIPAA compliant and designed to complement the tools practices already use.
Wing Assistant pairs that technology with skilled virtual assistants who take on the administrative work that pulls teams away from patient care. Kanwar writes on where automation and human support meet in health care operations, and how practice leaders can adopt both effectively. He shares updates on LinkedIn.
