Improve Prior Authorization Programs Using Analytics And AI

Prior authorization programs are management processes used by insurance companies to determine if a prescribed product or service will be covered. They can reduce total cost of care (TCOC) while ensuring that evidence-backed clinical protocols are followed. However, they also have a tradeoff: they can create administrative burdens and care delays for both members and providers.

This process can hurt the health plan’s net promoter scores (NPS) from members and providers. For Medicare Advantage plans, this can also affect the CAHPS survey results and lower star ratings. Health insurance carriers who do not act quickly risk falling further behind these large payers who have already taken steps to simplify their prior...