Managing prior authorizations (PAs) is an industry-wide challenge. PAs involve complex, varied procedures across different healthcare plans and providers' offices and serve as a key tool for controlling healthcare quality and costs. Lately, both health plans and providers have turned to AI to simplify the complex PA process. AI offers the opportunity to automate some of these complex tasks and expedite decision-making.

This innovation is part of a larger trend in revenue cycle management as organizations enhance efficiency and accuracy in their operations. These AI investments offer immediate, measurable ROI — especially as AI replaces outdated communication methods like phone and fax. The payer organization GuideWell successfully integrated AI into their prior authorization process, yielding significant gains in efficiency and provider satisfaction.