Case Studies

In 2019, many providers were asking a deceptively simple question: Should we buy or build prior authorization technology?

The ‘build’ camp was particularly attractive at the time as health systems saw an opportunity to leverage their internal IT teams to create tailored solutions that could integrate directly into workflows and be maintained in-house.

Fast forward to today, and that enthusiasm to build has tapered off. Why? Because prior authorization is one of the most multi-faceted, interconnected, and variable processes in all of healthcare. It touches dozens of systems, depends on clean and timely data from multiple sources, and requires deep knowledge of payer rules, coding logic, and clinical documentation. Building it internally isn’t just an IT project - it’s a full-scale operational transformation that demands expertise across revenue cycle, clinical operations, integration engineering, and AI-driven automation.

‍This guide offers a transparent look at the full continuum of considerations for anyone thinking about building or buying a prior authorization solution.