How AI can finally fix prior authorization

If you’ve ever been a patient waiting—days, sometimes more than a week—for treatment approval, or a clinician stuck chasing it, you know what prior authorization feels like. Patients sit in limbo, anxiety growing as care stalls. Nurses and physicians trade hours of patient time for phone calls, faxes, and glitchy portals. Everyone waits, some in pain, while the people on both sides of the system lose faith in it a little more each day.

This isn’t a minor inconvenience. According to the American Medical Association’s (AMA) 2024 Prior Authorization Physician Survey, 93% of physicians report that prior authorization delays access to care, and 94% say it negatively affects patient outcomes. Physicians handle an average of nearly 40 requests each week, spending 13 hours of their time on the process. Nearly 9 out of 10 share that it’s a contributing factor to burnout.

We’ve been down this road for many years. In 2018, health insurer and provider groups signed a consensus statement promising significant improvement of prior authorization. In 2023, the AMA reported that two major insurers pledged to reduce the number of services needing prior authorization. 

The promises added up—so why hasn’t the burden eased?

Last month, AHIP (a national trade association representing the health insurance industry) and major payers rolled out six reforms standardizing electronic submissions, speeding decisions, improving transparency, and preserving continuity of care when members switch plans. More than 50 leading health plans, encompassing 257 million Americans, signed on to be a part of this reform with all commitments delivered by 2027. That’s important. But for someone awaiting chemotherapy or a nurse on the ward, 2027 feels like forever away.

No need to wait

Real reform doesn’t need to wait. Here’s what’s already happening inside health plans that have embraced agent‑based AI systems—technology is being put in place that’s designed not just to speed up forms but to fundamentally change how prior authorization and other core operations get done. These systems don’t replace people. They work alongside nurses, case managers, and administrators, handling the repetitive, document-heavy work so humans can focus on clinical decisions and patient care.

Tangible results

This AI is just beginning to be adopted by plans; the transformation is measurable:

• Turnaround times are slashed by more than 50%.
• 76% of authorizations are handled automatically.
• Eighteen minutes are saved per prior authorization request, which for an average-sized health plan unlocks tens of thousands of hours each month, that enables clinical care teams to shift from administrative work to greater focus on patients.
• AI can handle the tedious parts of the process—sorting through PDFs, faxes, and clinical notes—in seconds instead of hours, while keeping nurses and physicians involved for the decisions that require human judgment.

Paradigm shift

This isn’t just a tweak to the old process—it’s a shift that allows entire operations teams to work differently. Patients get quicker answers and fewer anxious phone calls. Providers get back more time to spend helping patients. For the people working behind the scenes, it means moving past the repetitive paperwork grind—hours spent sorting through forms, faxes, and files—and focusing on work that actually supports better care.

AHIP’s own language makes the case: these reforms are meant to provide faster access to evidence-based care, simplify workflows for providers, and preserve care continuity when people switch insurers. That should be the minimum standard—not a distant promise.

Health plans need to act now—scaling existing AI deployments and embracing process redesign—so they can deliver three concrete outcomes today:

• Patients can start the treatments they need sooner, without the constant back‑and‑forth or long waits for approval.
• Doctors and nurses get back valuable time, so they can spend more of their day with patients instead of buried in forms and phone calls.
• People can keep their care moving, even if they switch insurance plans mid‑treatment, without having to start the approval process all over again.

Within reach

Health plans don’t need to wait for 2027. The technology exists today to deliver meaningful prior authorization reform. And let’s be honest: another round of press releases won’t change outcomes. But scaling the results and impact that AI is delivering to prior authorization today—that’s reform in motion. And it’s within reach.

For patients trapped in limbo and clinicians stretched thinner every day, reform can’t arrive soon enough. The question isn’t whether we can make prior authorization faster, simpler, and less needed. It’s when health plans will act—for the sake of all those involved in our health system, we must choose urgency. 

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