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Yes….. AI is here!


It’s ALIVE!!!  Artificial Intelligence is here.

The article below details how HCSC, which covers about 18 million members in Illinois, Montana, New Mexico, Oklahoma and Texas, has introduced the power of AI to fast-track their very hectic prior auth volume. The company received about 1.5 million prior authorization requests in 2022.

What is most impressive is that they claim prior auths can be processed 1,400 times faster than using the traditional method.  WOW! They say that AI technology is now used for 93% of HCSC members for a limited number of procedure codes while they ramp up AI to handle even more procedure codes. 

HCSC also developed  an algorithm that mines historical prior authorization approvals to make it easier to approve treatment within seconds. If the request for a prior auth meets all criteria it is approved with no human intervention. The requests that fall through the sifter then go into a traditional prior authorization review.

Will AI completely eliminate manual review?

— Unlikely, at least in the foreseeable future.

Specific procedure codes and requests for certain (many?) specialty medications are likely to still be subject to lots of review involving extra documentation such as lab tests, genetic testing, site of service, etc. etc. It is conceivable that even these elements could be automated….. but given the difficulty in linking all these disparate criteria into one platform will be a big challenge in the short term.


How HCSC is using AI to speed up prior authorization

Health Care Service Corporation says using augmented intelligence allows it to process prior authorization requests about 1,400 times faster than before. 

Jul 17, 2023  – Of the many tools that payers use to control costs, prior authorization ranks high on the list of what providers and patients find particularly vexing. However, Health Care Service Corporation hopes to fine-tune the process using the power of artificial intelligence. —–article continues—–

CLICK HERE to access the complete article


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