How AI Can Solve Prior Authorization - Insurance Thought Leadership

Physicians spend nearly two full business days per week on prior authorization requests as part of an antiquated, manual process. Prior authorization is the "single highest cost for the healthcare industry" in the U.S., totaling some $767 million a year, according to the CAQH index. Physicians spend nearly two full business days per week on prior authorization requests, and payers devote thousands of manhours reviewing and approving them in an antiquated, manual process involving phone calls and faxes. The arduous task often delays necessary treatment and sometimes results in treatment abandonment -- patients just get tired of waiting, so they give up -- both of which hurt patient outcomes and ultimately raise costs in the long run. Prior authorization has been identified as one of the biggest opportunities for applying artificial intelligence (AI) to help lower the administrative burden and cost.