War-game a prior auth backlog cut by proving each queue class has a named owner, a measured age-out, and a reverse path before draft cuts start governing every authorization claim.
Prior auth backlog cuts fail when "cut" means a status without a decision artifact, when teams dual-count a draft queue as both approved and live, and when high-risk payer classes still pin to one thin clerk because the queue inventory is incomplete. The review needs one written inventory of queue classes, one owner who can deny a risky shortcut, and a documented consequence when a failed queue ages past the deadline.
Freeze the cut under review
State which payer classes the cut covers, the effective date, which queue targets change, how evidence packs are versioned, and what happens to authorizations already in flight. Name the clinics that feel it first and the access promises that depend on coherent prior auth handling. If the memo mixes a prior auth backlog cut with a denial writeback rule and a length of stay target, split them. A war game needs one move under fire at a time.
Write the decision you will make if the war game finds nothing new. Also write the reverse criteria: the missed queue, coverage gap, or patient deadline that would force a cut rollback within a stated window.
Seat the prior auth room
- Claims ops. Queue timing, age-out math, and what the authorization forecast hides if exceptions soften after the policy.
- Utilization review. Clinical lag, dual-counted queues, and the message that would leave orphan authorizations open past lock.
- Payer ops. Authorization capacity, appeal load, and relationship damage with plans when queues jump overnight.
- Finance. Cash-cycle load, forecast promises that break in process, and the first ninety days of thicker remedies after a soft cut.
- Skeptic. The claim that looks strongest and is least sourced.
Give every seat the same exhibits: open queues, cuts in flight, protected payer classes, coverage commitments, and the age-out policy you intend to use. Private data for one seat invents agreement that will not survive the real room.
Pressure the soft queues
Feed Pingpong the cut memo, the queue exhibits, and the seating briefs. First pass steelmans the cut. Later passes attack from claims, utilization review, payer, and finance seats. Final pass turns surviving objections into phased queue rules, mitigations, or a changed recommendation. Agreement across passes is not proof. Keep the objections that still have evidence gaps.
Pair with the claims ops lead seat, the utilization review lead seat, a denial writeback rule, and a payer contract renewal stress test. More operating decisions live in the war-game decisions hub.
Ship the cut only when approved and blocked queue labels can be reproduced from stored prior auth exports without a verbal override.