In a latest survey by income cycle administration firm FinThrive, 73 p.c of respondents stated they’re utilizing AI and automation to streamline prior authorization. To fulfill this demand from well being system prospects, distributors reminiscent of ambient medical intelligence firm Abridge proceed to focus on enchancment of the prior authorization course of by partnerships involving its medical dialog instruments.
In 2025 Healthcare Innovation interviewed Pittsburgh-based Highmark Well being’s senior vice chairman and chief analytics officer, Richard Clarke, Ph.D., about how Highmark was deploying Abridge’s ambient medical documentation platform at its Allegheny Well being Community, and in addition co-developing with Abridge a previous authorization resolution on the level of dialog.
Now Abridge has introduced it’s engaged on a previous authorization resolution with Availity, which runs a real-time well being info community connecting well being plans and suppliers to streamline administrative and medical transactions. The businesses say their engagement makes use of know-how grounded within the clinician-patient dialog to facilitate a extra environment friendly course of between clinicians and well being plans in medical necessity evaluation.
Somewhat than creating parallel AI programs throughout healthcare stakeholders, Abridge and Availity say they’re working collectively to make sure shared medical context on the level of dialog powers administrative processes, reminiscent of prior authorization evaluation and submission, with the aim of bettering outcomes for sufferers and the groups delivering care.
Abridge’s AI platform serves greater than 200 well being programs and is projected to help over 80 million patient-clinician conversations in 2026. Availity says its FHIR-native APIs allow quick, scalable, and safe connectivity of payer info throughout all the healthcare ecosystem. With Abridge’s Contextual Reasoning Engine know-how, clinicians can achieve visibility into related medical info in the course of the dialog to help documentation aligned with prior authorization necessities.
“By embedding our know-how on the level of dialog, we’re enabling quicker, extra clear utilization administration selections rooted in medical context,” stated Russ Thomas, CEO of Availity, in an announcement. “We’re excited to collaborate with Abridge and to reveal what’s potential when payer intelligence meets real-time supplier workflows.”
The event of real-time prior authorization is only one element of a broader income cycle collaboration that’s targeted on making use of real-time conversational intelligence throughout the affected person, supplier, and payer experiences. The businesses intend to help integration by collaborating on workflow alignment between their respective platforms within the following areas:
• Simplified Prior Authorization: Aligning utilization administration and order submission throughout the dialog, with the aim of enabling payer dedication in the course of the go to
• Documentation Hole Visibility: Highlighting documentation gaps in the course of the dialog—not after—to help top quality, compliant, and clinically correct documentation that’s consultant of the affected person’s present situation
• Authorization Integrity: Supporting extra full and correct documentation on the level of dialog reduces downstream administrative cycles between payers and suppliers and retains the wants of the affected person on the middle of the request
• Lowered Administrative Burden: By supporting clinicians with prior authorization documentation and submission throughout a go to, the aim is to assist each payers and suppliers cut back handbook workflows, administrative delays, and different time- and resource-intensive wants, reminiscent of peer-to-peer consults
At Highmark, Clarke defined that Abridge’s ambient medical intelligence is getting used to cut back documentation burden for clinicians on the level of care. “However we’re additionally speaking about the way it can cut back friction between payer and supplier. Step one can be within the prior authorization work that we’re doing collectively, however we see many extra alternatives sooner or later to deliver payer-related insights into workflow to enhance well being outcomes and create extra reasonably priced care.”
The primary part of the collaboration entails implementing Abridge’s ambient medical intelligence platform at Allegheny Well being Community’s workplace places and hospitals.
Highmark defined that till now, most makes an attempt at fixing the challenges of prior authorization have targeted on streamlining the approval course of post-encounter, however on this resolution the authorization course of will now occur on the level of dialog.
Abridge’s AI resolution automates duties reminiscent of finishing varieties, submitting and reviewing requests, monitoring their standing, and figuring out when prior authorization is required within the first place. Clinicians stay on the helm of the method, reviewing all AI-generated suggestions earlier than something is submitted, and can be capable to perceive in real-time whether or not they have insufficient proof for a previous authorization, Highmark stated.
This partnership will construct on Highmark’s earlier efforts round prior authorization, Clarke confused. “We’ve been targeted very intently on persevering with to enhance that have. We have been doing that with each Allegheny Well being Community in addition to different supplier companions by our energetic “gold carding” program,” he stated. “We’re not simply gold carding suppliers primarily based on their historic efficiency, but additionally actively working with suppliers assist them perceive what necessities they could be lacking, to assist them get to a few of these thresholds to grow to be gold card. As a result of we have been doing all that work, we had been rather well positioned to accomplice with Abridge. We stated let’s take the pure subsequent step to deliver that into the precise dialog between clinician and affected person on the level of care.”
