What You Should Know:
– Humata Health, the leader in delivering AI-powered touchless prior authorizations, today announced that Allegheny Health Network (AHN) is the first health system to implement truly touchless medical prior authorization.
– By simply entering an order for a procedure into an electronic health record (EHR), AHN can now receive prior authorization from payers without any other human intervention, thanks to Humata’s artificial intelligence and automation technology.
Allegheny Health Network Expands Touchless Prior Authorization Initiative with Humata Health
Allegheny Health Network (AHN), a leading integrated healthcare delivery system serving Western Pennsylvania, continues to advance patient care and operational efficiency through its innovative partnership with Humata Health. The network, which includes 14 hospitals, multiple ambulatory surgery centers, Health + Wellness Pavilions, and hundreds of physician practice locations, is supported by more than 2,600 physicians and 22,000 employees.
Building on their prior success in automating over 200,000 prior authorizations annually with a first-pass approval rate of 96%, AHN and Humata Health have launched a significant expansion of their touchless prior authorization initiative. In the first month alone, 70% of requests for Current Procedural Terminology (CPT) codes covered under the new program were approved without any staff involvement after care teams placed orders through the electronic health record (EHR) system.
Initially applied to select imaging and radiology procedures, Humata Health’s technology is now extending across additional procedures and service lines. This automation is powered by artificial intelligence and clinical automation technology, which ensures that accurate, bundled clinical information is submitted seamlessly to payers, simplifying the authorization process.
Humata’s end-to-end touchless prior authorization solution for AHN includes:
- Authorization determination: Automatically verifying whether prior authorization is required for a specified CPT code once an order is placed.
- Clinical package generation: Selecting, indexing, and classifying the appropriate clinical documentation according to the procedure’s requirements and payer policies.
- Submission: Seamlessly integrating with payers and delegated entities to enable automatic clinical documentation exchange and prior authorization submission.
- Status monitoring: Proactively checking authorization status and alerting care teams only in cases requiring human intervention, such as denials or peer-to-peer reviews.
- Post-authorization monitoring: Continuously tracking approved authorizations for 14 days post-procedure to detect any changes—such as updates to insurance coverage, diagnosis code modifications, or procedure rescheduling—that could invalidate prior approval.
Morgan Kroskie, Corporate Director of the Central Authorization Department at AHN, emphasized the initiative’s impact, stating that removing administrative burdens from care teams while accelerating access to care for patients aligns with AHN’s mission of providing remarkable clinical experiences. She highlighted that Humata’s touchless technology is delivering substantial value and noted AHN’s commitment to further expanding the solution across a broader array of procedures and service lines.
