Providers are betting on artificial intelligence to ease the pain point of prior authorization, a new survey shows.
Cohere Health, which provides clinical intelligence to insurers and risk-bearing providers, polled 200 clinicians and office administrators and found that 99% of clinicians report confidence in using AI to back prior authorization. Most (96%) office administrators said the same.
Two-thirds of those surveyed said a completely digital prior authorization process would significantly improve their workflows. Across the board, the respondents said the process should have real-time tracking baked into the experience, allowing them to track the status of key requests.
“Providers are speaking loud and clear: they want and deserve a prior authorization process that is smarter, simpler and more transparent,” said Brian Covino, M.D., chief medical officer of Cohere Health, in an announcement.
The survey also highlighted where providers are still seeing delays and hurdles related to prior authorization as well as where the technology lags in terms of making the process all-digital.
Insurers will be under new prior authorization requirements from the feds starting Jan. 1, which will require them to respond more quickly to submitted requests. Under the rule, they'll have 72 hours to respond to urgent requests and seven days for other submissions; per the Cohere survey, just 12% of clinicians and 7% of administrators say they receive submissions in that time frame at present.
In addition, 97% of surveyed administrators and 93% of clinicians said they have seen delays in prior authorization lead to emergency care or hospitalizations that would otherwise have been avoided. More than half (55%) said they have seen patients abandon their treatments amid prior authorization delays.
Most administrators (95%) and 92% of clinicians said prior authorization is a significant burden, and 1 in 10 of the surveyed clinicians said it contributes to burnout.
However, while they said technology is the likely answer to easing these burdens, just 16% of the surveyed administrators and 24% of clinicians said they use electronic platforms to submit 40% or more of prior authorization requests.
About a quarter of prior authorization requests are submitted instead via fax or by phone, per the survey.
Administrators and clinicians were also frequently unclear on whether services require a prior authorization, the survey found.