Using AI to Streamline Prior Authorization

Prior authorization is the request made from a medical provider to a health plan in order to ensure that insurance payers can be approved to receive covered medical care. This system was invented in order to protect resources and save money, however, the submission and approval process presents some challenges.

Studies have shown that 1 in 3 providers say that prior authorization processing delays have led to an adverse event for patients. The current manual method of submitting authorization requests is time consuming, prone to error, and tedious. This traditional method may be at the root of these issues, which has led experts to develop an AI backed prior authorization process automation. This new system uses patient data to automatically identify payer status and retrieve necessary data without the in between steps. Artificial intelligence also can help to field calls and automatically update medical records.

There are many side effects of poor prior authorization. Higher costs, delays in access to care, and even life-threatening events can occur under the traditional system. Fortunately, both patients and providers are worried about these disturbing new trends and are endorsing new automated technology. AI powered solutions can offer a number of benefits that will alleviate the current stressors of the prior authorization process in the healthcare industry.