Prior authorization is a process used by health plans to approve or deny coverage for services before they are provided, intended to reduce unnecessary healthcare costs. However, it presents significant challenges for healthcare providers who must navigate documentation and regulatory burdens. Despite being a major obstacle in patient care delivery, prior authorization is not likely to be eliminated. Solutions to improve this system, particularly through automation and AI, are being explored to make the process more efficient without adding complexity to healthcare workflows. Click here for article.
Prior authorization is a critical, yet burdensome process in U.S. healthcare that helps control costs but can hinder patient care.
Providers face significant challenges in managing prior authorization, often more than with other regulatory requirements like EHR systems.
Automating aspects of prior authorization using AI could help reduce the workload on providers and streamline the process.
Adoption of automation tools must be carefully managed to avoid adding new burdens to healthcare workflows.
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