Radiology occupies a unique position in the prior-authorization landscape: the specialty has become both a destination for PA-gated studies and — for groups with a referring practice — a facilitator of PA processes that originate with the ordering physician. When a scan doesn’t happen because authorization didn’t clear, the clinical cost lands on the patient and the ordering clinician, but the radiology group carries the scheduling and revenue impact.
The mechanism that makes radiology PA distinctive is the radiology benefits manager.
The numbers in radiology
Industry surveys and advocacy data from the American College of Radiology document the scope:
- ~30% of outpatient advanced imaging orders now require prior authorization through an RBM or payer.
- CT, MRI, nuclear medicine, and PET are the most commonly gated modalities.
- PA requirements for imaging have expanded significantly since 2015, as more commercial payers contracted RBMs to manage imaging utilization.
These ride on the baseline every physician reports: 39 authorizations per week, roughly 13 hours lost to them, and 93% reporting PA delays patient care (AMA 2024). For radiology practices, the volume is high and the turnaround pressure is compounded by scheduling windows — a scan that can’t be authorized before the patient’s window expires means a reschedule, not just a delay.
Why radiology is different
- The RBM layer. AIM Specialty Health (now Carelon) and similar companies operate a separate authorization system for many commercial payers. A referring physician who authorizes through their payer’s standard process may still need a separate RBM authorization for the imaging study — and the two systems don’t communicate automatically.
- Clinical-indication matching. RBMs apply their own criteria to imaging orders, which may differ from the referring physician’s clinical reasoning. An order that is clinically indicated may not meet an RBM’s specific criteria as initially submitted, triggering a peer-to-peer or addendum request.
- Scheduling pressure. Unlike a medication where a delay means a patient waits longer, an imaging delay means a scheduling slot goes empty. A scan authorized after the patient’s appointment window means a cancellation and a rebooking — compounding the operational impact of every PA that doesn’t clear in time.
- Interventional procedures. For practices doing interventional radiology — biopsies, drainages, embolizations, vascular procedures — each procedure typically requires its own PA, adding authorization volume on top of the diagnostic imaging load.
What it costs
The operational cost is staff time managing a dual-system authorization process — the payer’s standard PA and the RBM’s separate portal — for roughly 30% of advanced imaging orders. Studies and ACR surveys document that imaging PA contributes to study abandonment, delayed diagnoses, and rescheduled procedures. For a radiology practice, an abandoned study is lost revenue; for the patient, a delayed diagnosis is a delayed treatment decision. At roughly $10.81 per manually processed authorization (CAQH 2023), a practice running high imaging volume accumulates significant PA overhead — before counting the scheduling inefficiency.
How to cut the wait
Imaging PA documentation is structured clinical data: indication, relevant clinical history, prior imaging, referring physician’s clinical question. Artificer Health:
- Assembles the clinical indication packet from the order and relevant prior records, formatted to each payer’s and RBM’s specific documentation requirements.
- Routes to the correct system — payer PA or RBM portal — so the authorization lands in the right queue the first time and doesn’t require a re-submission when it arrives in the wrong system.
- Tracks pending authorizations against the scheduling window so the practice knows in advance which studies need to be rescheduled and which are on track to clear before the patient’s appointment.
For a radiology practice, a PA that clears in hours rather than days is the difference between a full schedule and a rescheduled slot.
Sources: American College of Radiology advocacy data and practice surveys; ACR / RBMA industry analysis on imaging PA penetration (~30% of outpatient advanced imaging); AMA 2024 Prior Authorization Physician Survey (n=1,000); CAQH 2023 Index.