Photo: Courtesy UnitedHealth Group
Optum is introducing AI-powered prior authorization.
Optum said the intelligent automation solution delivers timely decisions for providers to reduce delays, speed approvals and reduce repetitive work.
Allina Health will be one of the first to deploy this new solution, Optum said. Allina Health is a nonprofit healthcare system based in Minneapolis, Minnesota, that owns or operates 12 hospitals.
WHY THIS MATTERS
The new system touts 45% manual touches, a 56% reduction in review time, 80% greater documentation bundling efficiency and a 96% first-pass approval rate.
Providers can submit requests through Digital Auth Complete by Humata Health, a physician-led AI startup. The AI-enabled authorization features can be embedded directly into the EHR. The system gathers required materials, applies payer rules and submits requests automatically, Optum said.
Payers can use InterQual Auth Accelerator.
“We’re transforming the prior authorization process to address the friction it causes,” said Dr. John Kontor, senior vice president of clinical technology at Optum Insight. “By uniting clinical data, evidence-based criteria, and human-centered AI at every step, we’re making it simpler and faster for patients to get appropriate care.”
“With Optum, our goal is to make prior authorization virtually invisible to providers and patients,” said Dr. Jeremy Friese, CEO of Humata Health. “By embedding real-time approvals and AI-driven automation into clinical workflows, we’re reducing administrative burden and helping patients get timely care.”
THE LARGER TREND
Many major health plans have pledged to simplify the prior authorization process.
The Centers for Medicare & Medicaid Services also requires payers to speed up the process by authorizing urgent requests within 72 hours and standard requests within seven days. That rule went into effect on Jan. 1.
The new digital prior authorization solutions reflect the direction set by Optum Real, using the same AI capabilities behind real‑time authorization decisions to support a wider range of clinical and administrative needs, Optum said.
Email the writer: SMorse@himss.org