In this episode of For the Love of Revenue Cycle, Vanessa breaks down why prior authorization and eligibility verification are two of the biggest drivers of preventable denials — and how getting them right is essential to clean claims and healthy cash flow. The discussion covers the foundations of payer requirements, the difference between denials and rejections, and where most revenue leakage actually occurs across the front end of the revenue cycle. Vanessa shares practical best practices for improving accuracy and efficiency in PA and EBV workflows, along with real industry data on denial trends. The episode also explores how modern technology, including agentic AI, is transforming these processes by reducing manual work, closing operational gaps, and shifting organizations from denial resolution to true prevention.
00:00 Welcome and Introduction
03:07 Understanding Clean Claims
06:04 Claim Requirements Explained
10:41 Denials vs Rejections
12:25 Why Prevention Matters
17:05 Front End vs Backend
22:05 Prior Authorization Deep Dive
26:28 PA Process Step by Step
29:34 Prior Authorization Best Practices
32:15 Eligibility and Benefit Verification
35:55 EBV Best Practices
38:52 Technology and AI Overview
42:30 Understanding Agentic AI
44:48 AI in PA and EBV Workflows
48:04 Closing and Call to Action
