Introduction

Relationships between health plans and providers are growing increasingly strained. Recent headlines highlight growing concern about prior authorization requirements and claims denials — issues that have eroded provider trust and even driven plan-provider contract terminations. In a 2025 AJMC survey, 89% of clinicians reported that prior authorization requirements contribute to burnout, amplifying frustration while also eroding confidence in plan partnerships.

Methodology

To build on the existing body of literature, Advisory Board conducted a survey of frontline clinicians and administrators about their experiences with the processes around prior authorization, claims denials, and appeals processes. This research was supplemented by qualitative interviews, providing detailed insights into provider time spend and experience across nine major steps in the prior authorization and claims denial processes.