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Points of Light 2023 Case Study 13
Automating Prior Authorization Determinations with AI
Author
Boyd Stewart
Author
Aurene Wilford
The prior authorization process can be a frustrating experience for all involved—patients, payers, and providers. The collaborators in this case study utilized AI technology to automate tasks at every step of the process—from submission to final decision. Regular communication between the collaborators helped make the implementation successful, and reported results include less manual work for the payer and provider organizations, faster authorization decisions (and thus faster access to care), and fewer denials.
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Key Findings:
- Executive Summary
- The Collaborators
- Points of Friction—Challenges to Be Solved
- Action Plan—How the Collaborators Worked Together to Reduce Friction
- Points of Light—Outcomes Achieved through Collaboration
- Lessons Learned—What Best Practices Can Other Organizations Replicate?
- What's Next?—Vision for the Future
Writer
Elizabeth Pew
Designer
Jess Wallace-Simpson
Project Manager
Joel Sanchez
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.