In oncology, any delay in prior authorization can lead to postponed diagnoses or treatments. For Exact Sciences, this challenge is heightened by the volume of tests and variability among payers. Their tests, such as the significant breast recurrence score assay, are designed to predict the likelihood of cancer recurrence and assess how a patient might respond to chemotherapy. These tests are typically ordered during crucial decision-making moments. Any slowdown in the authorization process can frustrate providers and heighten patient anxiety, especially as organizations increasingly look to automation in prior authorization to prevent avoidable bottlenecks.
In a recent conversation, Liz Durkin, Manager of Revenue Cycle at Exact Sciences, shared how her team has reshaped their oncology authorization approach in partnership with Infinx through workflow redesign, deep payer knowledge, automation, and Epic integration. Their experience underscores both the opportunities and the ongoing challenges with prior authorization faced by high-complexity labs nationwide.
The High Stakes Reality of Oncology Prior Authorization
Exact Sciences operates as the connective layer between oncologists and payers. Once a test is ordered, the team has a narrow window to secure authorization before results are released. They must identify payer requirements, gather pathology reports and clinical documentation from multiple systems, validate medical necessity, and anticipate potential denial drivers. For many labs, this work has reinforced the value of strong prior authorization best practices that balance speed with precision.
Before working with Infinx, the organization had limited visibility into denial causes, inconsistent access to complete records, and the added strain of bringing billing in-house on Epic. They needed a partner who could keep up with the volume and complexity, one that understood oncology workflows rather than simply operating as a data-entry vendor.
Rebuilding the Prior Authorization Process With a Smarter Partner
Durkin’s priority was to find a partner who would think strategically with them, not simply follow instructions. With Infinx, the transition became an opportunity to question long-standing internal assumptions. Did every payer truly require the complete set of clinical elements they were collecting? Could documentation be streamlined while still supporting strong medical necessity?
Infinx’s teams refined the rules by sharing specific insights from payers, including when certain documents were no longer necessary and highlighting additional details critical to approval. Both teams embraced a test-and-learn mindset, experimenting with fax, phone, and portal strategies and even implementing multilingual outreach, including Spanish-language fax communications and a language line for Puerto Rico. Transparent reporting analyzed turnaround times for each action, including initial and secondary record requests and communication methods, resulting in more efficient, increasingly automated PA workflows.
Reducing Provider Burden Through BAAs
One of the most impactful levers for improved turnaround time has been provider enrollment and Business Associate Agreements. With BAAs in place, Infinx can initiate and manage authorizations on behalf of ordering providers rather than shifting the administrative burden back onto already overloaded oncology practices.
Durkin noted what every oncology revenue cycle leader understands: providers sometimes avoid ordering specific tests or initiating prior authorizations because they anticipate lengthy, complex interactions with payers. By shifting that burden to a specialized authorization team and formalizing workflows through BAAs, Exact Sciences has protected provider time, supported additional test volume, and helped ensure more patients receive the diagnostic insights their physicians need, while reducing friction through thoughtful prior-authorization automation.
Using Integration, Automation, and AI to Protect Turnaround Times
When the relationship began, Exact Sciences manually sent orders and documents to Infinx, an approach that quickly became unsustainable at scale. The subsequent Epic integration transformed the workflow. Orders and supporting documents now flow to Infinx within seconds of being placed in the provider portal, allowing authorization work to begin almost immediately.
Automation and emerging AI play a quiet but critical role. From order identification and document capture to in-development medical-necessity tools, automation has freed Durkin’s team to focus on payer strategy and exception handling rather than on data movement. As test volume has grown and new oncology assays with experimental CPT codes have launched, close collaboration and real-time feedback from Infinx’s onshore and offshore teams have enabled Exact Sciences to understand payer reactions and documentation needs quickly. This illustrates how prior authorization AI supports scalability and consistency.
Navigating Payer Variability and Scaling a Patient-First Approach
Payer variability across regions and lab benefit managers continues to escalate. Policy updates now occur throughout the year and are often unannounced, leading organizations to discover changes only after denials spike. Durkin’s team responds with rigorous documentation, ongoing communication with Infinx, and a commitment to understanding both the science behind each test and the lived realities of patients navigating cancer treatment.
For organizations that do not have the scale of Exact Sciences, Durkin recommends starting with a thorough understanding of each test, its medical necessity, and how payers evaluate it. From there, they can build workflows and partnerships based on that foundation. Passion for the patient, supported by disciplined documentation and payer education, remains essential in oncology prior authorization, even as the industry moves further toward automation to address rising authorization challenges.
If your organization is ready to reduce oncology authorization delays, protect provider time, and streamline access to high-value diagnostics through automation, AI, and expert support, explore how these tools can simplify oncology prior authorization—schedule a demo.