What You Should Know
Surescripts has expanded its Prior Authorization Automation solution, increasing the number of enabled clinicians by 50% since December 2025 to reach 68,000 prescribers across 42 major health systems.Automated prior authorization systems achieved a median approval time of just 18 seconds when clinical determination criteria were met, bypassing traditional manual forms, faxes, and telephone calls.Real-Time Prescription Benefit tools saved patients $19.7 million from
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Prior Authorization
The Prior Auth Panic: WEDI Survey Reveals Providers Are Stalling as the CMS API Deadline Looms
What You Should Know
The Mandate: The Centers for Medicare & Medicaid Services (CMS) Advancing Interoperability and Improving Prior Authorization Final Rule (CMS-0057-F) mandates the use of specific APIs to streamline data exchange by January 1, 2027.The Payer Rebound: According to WEDI's February 2026 survey, payers have made massive strides. Only 10% report having not yet started their prior authorization API work—a sharp drop from 43% in late 2025.The Provider Paralysis: Providers,
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Optum Launches AI Platform to Erase Prior Auth Friction
What You Should Know
The Launch: Optum is rolling out a dual-sided AI strategy to modernize prior authorization: Digital Auth Complete for providers (powered by Humata Health) and InterQual® Auth Accelerator for payers.The Provider Impact: By embedding AI directly into the EHR, the provider-side tool has demonstrated a 96% first-pass approval rate in early deployments, aiming to reclaim the average 13 hours per week staff spend on these tasks.The Payer Impact: The payer-side solution focuses
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Abridge and Availity Partner to Automate Prior Authorization at the Point of Conversation
What You Should Know
- Abridge, the leader in clinical conversational AI, and Availity, the nation’s largest health information network, have launched a first-of-its-kind collaboration to automate prior authorization in real-time.
- By embedding Availity’s FHIR-native Intelligent Utilization Management solution into Abridge’s Contextual Reasoning Engine, the partnership aims to provide clinicians with visibility into coverage requirements and enable payer determinations during the
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Why Faster Prior Authorizations Won’t Fix Healthcare’s Real Issues
Few phrases raise blood pressure among doctors and patients like “prior authorization.” Ask any clinician and you’ll hear the same story: delayed treatments, endless back-and-forth, and vulnerable individuals left waiting while paperwork wins the day.
For providers, prior authorizations are a constant drain of time and energy. For patients, they can mean worsening conditions, missed windows for effective treatment, or even care that never arrives at all. And for payers, prior
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AI Prior Authorization: Humata Health Partners with CMS on WISeR Model to Modernize Medicare
What You Should Know:
- Humata Health, a provider of AI-powered prior authorization technology, has been selected by the Centers for Medicare & Medicaid Services (CMS) as a key partner for its new initiative: the Wasteful and Inappropriate Service Reduction (WISeR) model.
- CMS, the single largest payer for healthcare in the U.S., has chosen Humata Health to deploy its proprietary technology in a program that directly addresses the staggering variability of care and significant
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SPRY PT Launches AI-Powered Prior Authorization Solution to Automate 80% of Workflow
What You Should Know:
- SPRY PT today unveiled the industry’s first AI-powered Prior Authorization & Eligibility solution, proven to automate 80% of the prior authorization workflow while ensuring 100% of authorizations are completed through a combination of AI automation and expert review.
- The solution reduces related denials by up to 75%, streamlines workflows across major payers including Carelon/BCBS, UnitedHealthcare, and Humana, and provides unlimited, real-time eligibility
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Oracle Health to Launch AI-Powered Solutions for Payers and Providers
What You Should Know:
- Oracle Health has unveiled a new strategy to strengthen the collaboration between healthcare providers and payers.
- The company plans to introduce a comprehensive suite of AI-powered apps and agents designed to automate prior authorizations, reduce claims denials, and improve care coordination. These solutions aim to significantly cut down on administrative costs, which are estimated at approximately $200B annually, and enhance value-based care
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HHS Regulatory Breakthrough to Streamline Prior Authorizations and Improve Drug Price Transparency
What You Should Know:
- The U.S. Department of Health and Human Services (HHS) has announced a new regulatory reform that will give doctors and patients real-time access to prescription drug information.
- The rule, which takes effect on October 1, will allow millions of Americans for the first time to compare drug prices, view out-of-pocket costs, and access prior authorization requirements. The reform aims to help them identify the most cost-effective treatments and prevent
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Inovalon and Google Cloud Partner to Launch AI-Enabled Prior Authorization Solution
What You Should Know:
- Inovalon, a provider of solutions that empower data-driven healthcare, has announced a new collaboration with Google Cloud to develop an AI-enabled solution designed to address administrative burdens in the healthcare industry.
- The partnership will combine Inovalon’s extensive data solutions and subject matter expertise with Google Cloud's advanced AI and machine learning capabilities to tackle time-consuming prior authorization processes.
A Vision for
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