Innovaccer launches AI prior authorization tool

Prior authorization remains one of the top frustrations for physicians. A 2024 American Medical Association survey found that 94% of physicians reported delayed care tied to prior authorization requirements. Another 27% said that requests are often or always denied, and 95% of physicians say the process somewhat or significantly fuels burnout.

Despite years of policy debates, many authorizations are still handled through phone calls, faxes and disparate payer portals.

On Tuesday, San Francisco-based health care artificial intelligence (AI) firm Innovaccer announced a new tool that they say can streamline the process. Flow Auth is an AI-driven solution designed to automate prior authorizations from eligibility detection through appeals. It’s the latest addition to Innovaccer’s revenue cycle platform, Flow.

Automation from start to finish

According to an Innovaccer news release, Flow Auth integrates with major electronic health records (EHRs) and payer systems, proactively flags when an order requires prior authorization, and automatically builds submission packets tailored to each payer’s requirements. The system can transmit requests through APIs, portals or fax, and monitors status updates in real time.

If a request is denied, Flow Auth drafts an appeal letter using payer-specific policies and historical data. Innovaccer projects that the tool could cut physician time spent on prior authorizations in half, double staff productivity and deliver up to five times return on investment for health systems by reducing denials and accelerating approvals.

Industry adoption

Nationally, only about 30% of prior authorizations are submitted electronically, according to the Council for Affordable Quality Healthcare (CAQH). That leaves the majority still routed through manual and inefficient channels.

Innovaccer positions Flow Auth as a way to close that gap by standardizing submissions and minimizing human error.

The company says the tool supports a wide range of major payers, including UnitedHealthcare, Humana, Aetna, Anthem and Blue Cross Blue Shield plans. Additional payers can be added based on customer needs.

“Prior authorization should never stand between a patient and the care they need,” said Abhinav Shashank, co-founder and CEO at Innovaccer. “Every day lost to paperwork is a day a patient waits in uncertainty. Flow Auth changes that by removing the administrative roadblocks substantially. It keeps the process invisible to patients, effortless for providers and always aligned with the latest payer requirements. This is about giving clinicians back their time and patients back their speed to care.”

While health systems and physician practices have long called for regulatory relief, medical technology vendors continue to push automation as a partial solution to the prior authorization dilemma. Whether Flow Auth and any similar tools can deliver measurable improvements in patient outcomes across different practice settings remains to be seen, but the demand for solutions is certain.