What You Should Know
Blue Cross Blue Shield of Massachusetts (BCBSMA) and regional health system Tufts Medicine announced a comprehensive alliance, focused on prior authorization automation, value-based care design, and integrated clinical network delivery.Tufts Medicine is deploying Humata Health to automate and streamline prior authorization for Blue Cross members, starting with outpatient diagnostic imaging (such as MRIs), with scheduled expansion across additional clinical service
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Prior Authorization
Otter Health Lands $8M to Replace Prior Authorization with Continuous Clinical Intelligence
What You Should Know
Healthcare utilization intelligence platform Otter Health announced its official commercial launch, backed by $8M in seed financing co-led by Fika Ventures and Evidenced, with participation from Slow Ventures, Metrodora, CoFound Partners, Layout Ventures, Patient Capital, and Semper Virens.Directly challenges the foundational premise of conventional utilization management (UM): while health plans have historically relied on prior authorization (PA) as a transactional
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R1 to Acquire Humata Health, Advancing Phare OS with AI-Powered Prior Authorization Automation
What You Should Know
R1 entered into a definitive agreement to acquire Humata Health, an AI-powered prior authorization technology company, to embed agentic, touchless authorization capabilities into R1’s Phare Operating System (Phare OS).The transaction is expected to close by the end of the third quarter of 2026, with the Humata team joining R1’s R37 innovation lab to accelerate agentic AI engineering across the revenue cycle.Prior authorizations remain a top-three driver of hospital claim
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Surescripts Expands Prior Authorization Automation: Slashing Prescription Approval Times as New CMS Interoperability Rules Loom
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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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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