Lowering the Costs of Care through High-Performance Pre-certifications

The Challenge

Traditional prior authorization models offer health plan utilization controls but often involve slow approvals and frequent denials. National data show that prior authorization delays contribute to increased emergency department visits, hospitalizations, and additional office visits, driving up total cost of care while adding unnecessary friction for members.

Our Solution

OneVeracity’s high-performance pre-certification model reduces delayed treatment and avoids high-cost downstream events. Our approach involves:

• Rapid clinical review processes to deliver decisions well ahead of industry benchmarks

• Proactive provider outreach to obtain additional clinical information before issuing denials

• Provider collaboration to resolve documentation gaps and avoid unnecessary appeals

• Utilization management controls to ensure services remain clinically appropriate while minimizing delays

One client who implemented our approach achieved near real-time access to care with virtually no friction for members to receive clinically appropriate services, while maintaining necessary utilization controls for the employer.

Our Impact

Our pre-certification program’s results illustrate that a collaborative, clinically driven pre-certification program can improve access to care while helping employers control healthcare costs.

• 1.4 day average pre-certification turnaround time (vs. up to 7 days by most major carriers)¹

• 0.5% denial rate (vs. the national average of 19.1%)²

• 99.5% approval rate for clinically appropriate services

• Reduced administrative burden through fewer appeals and resubmissions

• Lower risk of avoidable emergency department visits and hospitalizations, and associated costs, caused by delayed care³

Faster Access to Care Leads to Lower Total Cost of Care

OneVeracity helps employers reduce unnecessary healthcare spending by accelerating access to appropriate care. Through proactive provider engagement and evidence-based clinical review, employers improve long-term cost control and members receive better, faster care with minimal administrative friction.

Looking for a smarter approach to manage utilization and ensure high-quality care? Let’s connect.


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Sources

1. Linear Health. “How Long Does Prior Authorization Take?” LinearHealth.com, 2024.

2. Muni Health. “Insurance Denial Rate by Company (2026).” Muni.Health, 2026.

3. American Medical Association. “Prior Authorization Delays Care and Increases Health Care Costs.” AMA-Assn.org, 2024.