Could an artificial intelligence approach to prior authorization be more human?

Leslie A Lenert¹, Steven Lane², Ramsey Wehbe³

¹Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, USA.

²Health Gorilla, Mountain View, California, USA.

³Department of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA.

PubMed PMC DOI PDF

Abstract

Prior authorization (PA) may be a necessary evil within the healthcare system, contributing to physician burnout and delaying necessary care, but also allowing payers to prevent wasting resources on redundant, expensive, and/or ineffective care. PA has become an "informatics issue" with the rise of automated methods for PA review, championed in the Health Level 7 International's (HL7's) DaVinci Pr…

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