Prior Authorization Under Public Scrutiny
A practical guide for health plans: find where prior authorization requests wait, give AI a defined job and test the change in a 90-day pilot.
A prior authorization request can arrive electronically in seconds and still wait days for a decision. When the work spans intake platforms, utilization management systems and delegated vendors, a status of “pending” says little about what is holding the request. This guide shows how to find which task is open, who owns it and where AI can help move it forward.
What's inside
- A regulatory timing summary
- A responsibility map with potential AI support
- A diagnostic for finding where requests wait
- A task map for giving AI a defined job
- Seven questions for a delivery partner
- A 90-day pilot framework and scorecard
Who it's for
For health plan leaders in utilization management, clinical operations, compliance and appeals
