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Monday, April 25, 2022

AI Ushers in next-gen Prior Authorization in Healthcare

Had yet to see this specific kind of application

AI ushers in next-gen prior authorization in healthcare in McKinsey

Healthcare payers recognize prior authorization as a core administrative process that’s ripe for improvement with artificial intelligence.

Healthcare payers recognize that prior authorization (PA) is ripe for improvement. AI-enabled PA design may deliver substantial financial, user-experience, and care benefits.


Artificial intelligence—the simulation of human intelligence by machines—is rapidly becoming a key enabler for businesses to deliver consistent, high-quality, and efficient outcomes. Healthcare organizations across the value chain are making significant strides in embedding AI capabilities in areas such as diagnostics, medical imaging, and lifestyle management.1

One healthcare process that could potentially be improved through the application of AI is prior authorization (PA). PA is a core administrative process in which payers require providers to obtain preapproval to administer a service or a medication as a condition of coverage. The goal of PA is to ensure members receive the most appropriate care for their medical needs in alignment with the latest medical evidence and guidelines. PA can prevent wholly inappropriate service utilization or, more commonly, ensure that first-line treatments are attempted before escalating to more invasive or risky therapies.  .... ' 

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