With regulatory scrutiny intensifying and the demand for speed, compliance, and clarity growing, understanding the nuanced differences between AI approaches is essential for payers, providers, and patients alike.
More than 50 major insurers have pledged to streamline prior authorization starting in 2026, but providers remain cautiously optimistic and skeptical that the changes will truly reduce burden or delays in care.
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Health systems should take the lead in fixing the broken prior authorization process, said Jeff Balser, CEO of Vanderbilt University Medical Center, during a recent conference. He highlighted AI, better workflows and centralized support as ways to reduce delays.
Thirteen House Democrats introduced eight bills to rein in Medicare Advantage and bolster traditional Medicare.
Across the nation, state-based health insurance exchanges are searching for ways to better serve their communities while making enrollment easier, more personal, and more accessible for everyone.
AI and advanced analytics can help organizations move beyond incremental fixes, streamlining access and improving patient experience, without overburdening staff or budgets.
Guideline directed care pathways are a way to shift from transactional PA, where each service requires separate approval, to an episode-of-care model.
Cohere Health and Microsoft have teamed up to use ambient listening and AI to simplify and speed up the prior authorization process, part of a broader industry shift toward reducing paperwork and improving care at the point of service.
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Highmark Health recently announced a partnership with AI technology company Abridge to deploy its ambient clinical documentation platform across Allegheny Health Network and co-develop a new prior authorization solution.
It’s a meaningful step. But declarations alone won’t fix a system still powered by fax machines, phone calls, and inconsistent rules. Real progress will require a modern digital infrastructure, aligned incentives, and coordinated action across both the public and private sectors.
Without systemic redesign, these efforts risk reinforcing the same pain points that made prior authorization a flashpoint for payers and providers.
By keeping our AI and ML grounded in real-world medicine, we can shape a future where prior authorization works smarter, faster, and better for everyone involved.
Ochsner Health is expanding its use of Latent Health’s AI platform after its reduced medication prior authorization times to just 4-5 minutes. The technology is designed to both streamline pharmacists’ workflows as well as improve patients’ access to medications.