Optimizing Prior Authorization in Oncology: Advanced Practice Provider-Led Approaches to Improve Efficiency and Timely Access to Care

Authors

• Paola Gonzalez, MPAS, PA-C, University of LynchburgFollow

Specialty

Oncology

Advisor

Dr. Sarah Bolander, DMSc, PA-C, DFAAPA

Abstract

Prior authorization and peer-to-peer (P2P) reviews have become significant barriers to delivering timely, evidence-based patient-centered cancer care. As treatment options expand and payer oversight intensifies, the administrative workload on clinical providers has grown substantially, with advanced practice providers (APPs) bearing a disproportionate share of that burden. Most P2P reviews arise from documentation gaps, including inconsistent or incomplete clinical details that are misaligned with payer criteria, combined with limited awareness among clinicians of the guidelines that determine approval decisions. This paper explores how P2P reviews negatively impact oncology workflows and patient care. It describes how APP-led initiatives can streamline processes, reduce avoidable P2P reviews, and improve timely access to cancer care. APPs bring strong clinical judgment, a comprehensive understanding of treatment pathways, and frontline insight into practice operations. This positions them to effectively bridge the gap between administrative requirements and high-quality oncology care. Standardizing clinical documentation and aligning submissions with payer and NCCN criteria can help decrease denials and shorten treatment turnaround times. Strengthening communication across multidisciplinary teams further reduces the administrative burden on providers and patients. These changes support timely cancer treatment, enhance the patient experience, and restore viable clinical hours for direct patient care. Empowering APPs to lead these workflow innovations offers a practical, sustainable approach to improving efficiency, reducing barriers, and advancing patient-centered outcomes in cancer care.

Recommended Citation

Gonzalez, MPAS, PA-C P. Optimizing Prior Authorization in Oncology: Advanced Practice Provider-Led Approaches to Improve Efficiency and Timely Access to Care. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).