{"id":39979,"date":"2024-10-22T07:17:00","date_gmt":"2024-10-22T14:17:00","guid":{"rendered":"https:\/\/efaxunifiedstg.wpengine.com\/?p=39979"},"modified":"2025-10-29T09:06:18","modified_gmt":"2025-10-29T16:06:18","slug":"ai-can-help-solve-prior-auths-connectivity-problem","status":"publish","type":"post","link":"https:\/\/www.efax.com\/blog\/ai-can-help-solve-prior-auths-connectivity-problem","title":{"rendered":"AI Can Help Solve Prior Auth\u2019s Connectivity Problem"},"content":{"rendered":"\n

Nine out of 10 physicians say prior authorization negatively impacts patients\u2019 clinical outcomes, according to an American Medical Association (AMA) survey<\/a>. As the volume of prior authorization requests rises, physicians and patient advocates say the problem is only getting worse. In fact, a New York Times<\/em> opinion piece<\/a> describes prior authorization as \u201cmedical injustice disguised as paperwork.\u201d<\/p>\n\n\n\n

\u201cThese resources could be devoted to patient care; answering phones in a timely fashion,\u201d one gastroenterologist told The New York Times<\/em>. \u201cI might actually get to go home and see my family on a regular basis.\u201d<\/p>\n\n\n\n

Given Consensus\u2019 focus on improving the prior auth problem, I read a recent Politico<\/em> interview<\/a> with Epic\u2019s director of research and development with great interest. Notably, Derek De Young stated that he\u2019s \u201cvery, very bullish\u201d on artificial intelligence (AI) in healthcare, although he believed it could be a while before AI could be used for prior auth.<\/p>\n\n\n\n

Yet I would counter that prior authorization is an issue that AI is primed to solve right now. <\/p>\n\n\n\n

In De Young\u2019s view, lack of a national directory for hospitals and health plans to communicate is holding up efforts to transform prior auth with AI. In his view, the challenge is connectivity. That\u2019s true\u2014and that\u2019s why providers are relying on technologies they know, like fax, and applying AI to fax as a \u201cFHIR wrapper\u201d to bridge provider-to-provider and provider-to-payer communication gaps. <\/p>\n\n\n\n

It\u2019s an approach that provides a modern entrypoint for achieving the connectivity needed for prior auth regardless of where such requests originate. It also levels the prior auth playing field for organizations with less advanced tech resources.<\/p>\n\n\n\n

Making the Connection for Improved Prior Auth <\/strong><\/h2>\n\n\n\n

The way we should be thinking about AI for prior authorization is not as a \u201cDr. Chat GPT\u201d\u2014 assisting health plans with making clinical decisions regarding authorization of care\u2014but as a facilitator for delivering the right information, faster, to health plans.<\/p>\n\n\n\n

At Consensus, we believe AI in the form of natural language processing (NLP) and machine learning (ML) offers a pragmatic solution for automated information capture and exchange to support prior authorization. It\u2019s a solution that can be deployed using the technology healthcare organizations rely on most: digital fax.<\/p>\n\n\n\n

Consider, for example, Clarity<\/a>, which uses NLP and ML to extract unstructured data from faxed PDFs and even handwritten text and applies it to structured data fields in a prior authorization workflow.\u00a0At a time when seven out of 10 prior authorization requests<\/a> are submitted with unstructured data, solutions like Consensus Clarity can assist health plans and providers in leveraging AI to:<\/p>\n\n\n\n