Can AI and tech help streamline prior auths? Provider AI might end up battling payor AI

For many physicians, the prior authorization process is one of the most frustrating parts of practicing medicine. What was intended as a cost-control measure has become a significant administrative burden, taking time away from patient care and adding layers of complexity to routine clinical decisions. Physicians often find themselves spending hours navigating insurer requirements, tracking down documentation, and enduring delays that can negatively impact patient outcomes.

But artificial intelligence may be part of the solution.

We spoke with Brad Boyd of BDO USA about how new technologies are being developed to streamline and even automate parts of the prior authorization process. From reducing paperwork to identifying which procedures are likely to be approved, AI tools are showing promise in helping practices manage approvals more efficiently—and with less stress.

AI systems can now integrate with electronic health records to gather relevant clinical data, match it against payer criteria, and generate documentation in real time. Some platforms can flag missing information or alert staff to likely denials before they happen. Others can help determine when prior authorization isn’t required at all, eliminating unnecessary steps.

While not a silver bullet, AI offers the potential to reduce the time and cost associated with prior authorizations. And as regulations continue to push for greater transparency and speed in the process, many in the industry believe AI will play a critical role in helping practices adapt.

In this episode, Boyd discusses how provider AI might battle payor AI.