Answer to Prior Authorization Burden Reduction: Regulation vs. Automation
September 8, 2023
Rajesh “Raj” Godavarthi, Associate Vice President of Technology & Interoperability, MCG Health, Co-Lead for Prior Authorization Burden Reduction Use Cases at the HL7® Da Vinci Project, ONC HITAC Member
Daniel Cawood, Product Manager, Interoperability Solutions, MCG Health
The session provides market analysis of the current state of the prior auth burden reduction efforts. The topic of prior authorization regulation and automation is ubiquitous, as it seems to be mentioned or discussed on a daily basis. In addition to CMS proposed rule (PARDD API and FHIR), many states have enacted legislation or regulations related to prior authorization. There has been a flurry of companies that promise to revolutionize the prior authorization process using technology, particularly machine learning (ML) and artificial intelligence (AI). These companies seek to address the significant inefficiencies and pain points associated with the current manual prior authorization process by automating many of the tasks involved, such as verifying patient eligibility, identifying, and submitting prior authorization requests, and tracking the status of requests.