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). Provider-side and appeals workflows are seeing 40–70% cycle-time reduction in 2026 deployments.
Related terms
- Intelligent Document Processing — Intelligent document processing (IDP) is the automated extraction of structured data from unstructured or semi-structured documents — invoices, contracts, clinical notes — using OCR, NLP, and large language models, then routing the data to downstream systems.
- Workflow Automation — Workflow automation is the replacement of repetitive multi-step business processes with software that executes them deterministically, with optional human checkpoints at decision points.