Automation
Prior Authorization
Prior authorization is the insurer requirement that a clinician obtain approval before delivering certain services or medications. AI automates prior auth in three places: payer-side review (matching submissions to medical-necessity criteria), provider-side drafting (compiling the supporting documentation), and appeals drafting (composing the response when an authorization is denied).
Prior Authorization in practice
The parts that suit automation are assembling the supporting documents from the chart, filling payer forms and tracking status; the medical-necessity judgment stays with clinicians and payer reviewers. Prior authorization is mainly a US insurance process; in Canada, comparable approvals exist for some drugs under provincial and private plans, often called special authorization. Document assembly of this kind is built with document processing agents.
Related terms
- Intelligent Document Processing · Automation
- Workflow Automation · Automation