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The Rise of AI in U.S. Healthcare: Improving Prior Authorization

In a world increasingly reliant on technology, artificial intelligence (AI) is making significant strides within the healthcare sector. A recent survey conducted by Cohere Health® needs to be highlighted, revealing the impressive trust placed in AI to streamline the prior authorization (PA) process. This survey involved input from 200 healthcare professionals across the United States, showcasing the prevailing sentiment towards embracing digital-first solutions.

A Glimpse into the Survey Findings

The 2025 National Provider Survey on Prior Authorization indicated overwhelming support for AI adoption within the realm of healthcare. An astonishing 99% of clinicians and 96% of office administrators expressed confidence in AI-driven systems to facilitate PA approvals. This overwhelming endorsement underscores the pressing desire for innovative solutions aimed at reducing administrative strains, enhancing patient access to necessary care, and reinventing the approach toward PAs.

Dr. Brian Covino, Chief Medical Officer at Cohere Health, stated, "Providers are speaking loud and clear; they want and deserve a prior authorization process that is smarter, simpler, and more transparent." Such a statement emphasizes a clearer call from providers for an efficient PA process that can seamlessly align with the dynamic needs of modern healthcare.

Challenges Posed by Legacy Systems

Despite the enthusiastic outlook on AI, the survey also shed light on significant challenges stemming from outdated processes. Alarmingly, 97% of administrators and 93% of clinicians reported instances where delays in the PA process led to unnecessary hospitalizations or emergency care. Furthermore, 55% observed patients abandoning treatments due to prolonged PA delays, while 95% of administrators and 92% of clinicians described the PA procedure as burdensome.

There’s a tangible concern that the existing PA systems are not only hindering workflow but are also contributing to clinician burnout. Such insights make it evident that change is not just welcomed but necessary.

Embracing Modernization Through Digital Solutions

According to the survey, there is a resounding agreement among clinicians about the necessity to forge ahead with modernization initiatives. Approximately two-thirds of respondents opined that a fully digital PA experience could vastly improve their workflows, with nearly all asserting the importance of real-time tracking within the process. By leveraging AI technologies, health plans can create a more efficient PA process that aligns better with provider expectations.

It's noteworthy that currently, only a small fraction of providers utilizes electronic PA platforms effectively, with only 16% of office administrators and 24% of clinicians using them for more than 40% of submissions. Many still rely on traditional methods like fax or phone calls for submitting requests. A significant number of respondents remain unclear about health plan requirements—92% of clinicians and 89% of office administrators frequently express uncertainty about whether a treatment requires authorization, underscoring a crucial area for improvement.

The Urgency for Compliance and Innovation

As the healthcare landscape prepares for new federal mandates coming into effect on January 1, 2026, the spotlight is on health plans to embrace modernization swiftly. The CMS Interoperability and Prior Authorization Final Rule emphasizes the critical need for health plans to address PA requests efficiently—within 72 hours for urgent cases and seven days for standard requests. Alarmingly, today, only a mere 12% of clinicians and 7% of administrators receive decisions within these required timeframes, reinforcing the urgency for robust, AI-powered solutions.

Amidst these looming standards, Cohere Health is steadfast in its commitment to revolutionizing the PA process. By integrating responsible AI with clinical expertise, the organization aims to ensure that PA approvals are not just faster and easier but also equitable and transparent, ultimately allowing clinicians to devote more time to patient care.

For more in-depth insights, the detailed survey findings are encapsulated in Cohere Health's white paper titled "The Hidden Cost of Prior Authorization," accessible via their website. The trends presented illuminate a critical juncture in healthcare, urging all stakeholders to recognize the potential AI holds in creating a more efficient and patient-centered ecosystem.

As the healthcare industry continues to evolve, the importance of forging ahead with innovative solutions cannot be overstated. By harnessing the power of AI, providers can enhance their workflows significantly, resulting in a more streamlined and effective healthcare delivery system.