Optum is rolling out new AI-powered tools that aim to reduce delays associated with prior authorization.
The company unveiled two new platforms aimed at streamlining the decision process: Digital Auth Complete and InterQual Auth Accelerator. The former, supported by Humata Health, integrates into the electronic health record and automates multiple parts of the process to provide responses faster.
Optum said that Digital Auth Complete connects with more than 250 payer systems to identify orders that require prior authorization determinations and is able to surface a patient's current medical coverage for comparison with clinical documents.
Through the platform, Optum expects there to be 45% fewer manual touches necessary and 80% greater efficiency in bundling documents. The platform is set for a 96% first-pass approval rate, Optum said.
Optum said in the announcement that Allina Health, a 12-hospital system based in Minneapolis, will be the first provider to deploy the system. Allina is a regular innovation collaborator with Optum.
“We’re transforming the prior authorization process to address the friction it causes,” said John Kontor, M.D., senior vice president of clinical technology at Optum Insight, in the release. “By uniting clinical data, evidence-based criteria, and human-centered AI at every step, we’re making it simpler and faster for patients to get appropriate care.”
The InterQual Auth Accelerator tool, meanwhile, leans on AI to accelerate determinations. A trained AI compares submissions with coverage policies and other relevant documentation and makes a recommendation for a determination to the team, highlighting key evidence in the documents.
This allows decision makers to review information more quickly, accelerating responses, Optum said.
The platform allows users to customize the level of automation, though it will not make auto-denials, according to the website. Based on internal test data, Optum estimates that the tool will lead to a 56% reduction in review time compared to more traditional workflows, and said that insurers can lean on the tech to meet key compliance requirements around prior authorization and interoperability from the Centers for Medicare & Medicaid Services.
Optum added that it is partnering with a health system in New England to rethink prior authorization using InterQual Auth Accelerator.
The company said the new tools build on the launch of Optum Real, which was unveiled late last year. That platform also harnesses the power of AI to drive greater efficiency in claims processing.