Reforming Prior Authorization with AI and Machine Learning - insideBIGDATA

Healthcare providers are growing increasingly more comfortable with using AI-enabled software to improve patient care, from analyzing medical imaging to managing chronic diseases. While health plans have been slower to adopt AI and machine learning (ML), many are beginning to rely on these technologies in administrative areas such as claims management, and 62% of payers rank improving their AI/ML capabilities as an extremely high priority. The process by which health plans manage the cost of members' benefits is especially ripe for technological innovation. Health plans often require providers to obtain advance approval, or prior authorization (PA), for a wide range of procedures, services, and medications. The heavily manual PA process drives unnecessary resource cost and delays in care, which can lead to serious adverse events for patients.