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Points of Light 2025 Case Study 25
Removing Inefficiencies During Prior Authorization Using an AI-Enabled Clinical Reasoning Engine
Author
Boyd Stewart
Author
Aurene Wilford
Healthcare Organization 25’s prior authorization processes were creating an administrative burden on office staff and delaying patient care. Healthcare Organization 25 began working with Payer Organization 25 to find better solutions. The organizations partnered with HealthHelp, a WNS company, for utilization management and with Anterior for AI. The stakeholders collaborated on an AI-driven prior authorization solution that led to a 99% reduction in the time needed for authorization approvals, a high clinical accuracy rate, and increased savings.
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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
Natalie Hopkins
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. © 2025 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.