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Prior auth
Eight years of running one of these programs, and a list of the five things that break. Every vendor knows this list. Most of them will not show it to you before you sign.
By the CercaLabs team · Published July 28, 2026 · 6 minute read
Almost never because of the technology. In eight years of running a program that now handles about 150,000 transactions a month, the failures we have seen and caused trace back to five things, and four of them are organizational.
This is the list we would want to see before signing a contract, so here it is.
Portals change layout, add steps, rotate authentication and deprecate pages, on nobody’s schedule but their own. Automation built against a portal will break. That is not a design flaw to engineer away; it is a maintenance cost to budget for.
What separates a program that survives from one that dies in month nine is whether a named person owns the breakage with a same-day response commitment. Not a queue. A person.
Two design choices reduce the frequency:
If your vendor’s proposal has no maintenance line item, the proposal is incomplete.
This is the most expensive mistake and the easiest to make, because standardizing is boring and automating is exciting.
If two coordinators handle the same payor differently and only one gets approved first time, automating “the process” means picking one of them arbitrarily and encoding it at scale. You have now industrialized whichever version happened to get documented.
Standardize first. At our diagnostics client, workflow standardization was the unglamorous half of the engagement and the source of most of the results, including a measurable drop in onboarding time for new staff, which nobody had asked for.
The workflow everyone complains about most is usually the worst first choice. It is loud because it is complicated, and complicated means unstable, and unstable means the pilot fails in front of an audience.
Choose the first target on volume and stability, not on annoyance. A boring high-volume workflow that succeeds buys you the credibility to attempt the hard one. The reverse does not work.
“IT will give us a service account” is a project plan built on a sentence nobody has said yet. Security reviews take weeks and sometimes end in no.
Confirm the access route before scoping, in this order of preference:
The last row surprises people. Screen-level automation inside an attended session frequently clears a security review faster than a new integration, precisely because it introduces no new data path.
A program with no baseline cannot be defended at budget time. Before anything is built, record touches per claim, turnaround time, denial rate, and hours spent per week on the target workflow. Rough numbers are fine. No numbers is fatal.
Twelve months later, someone will ask whether the automation was worth it. Without a baseline the honest answer is “we think so,” and “we think so” loses to a hiring freeze.
The short version
Budget for maintenance. Standardize before automating. Pick a boring first target. Confirm access before scoping. Write down the baseline.
None of that is about the technology. If a vendor’s pitch is mostly about the tooling, they are answering a question that was not the risk.
Want a written read on which of your workflows is actually a good first candidate? That is what the teardown produces, in thirty minutes, at no cost.
Written by the CercaLabs team. Published July 28, 2026. If something here is wrong or out of date, tell us and we will fix it.
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