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savingadvice.com /1 month ago

CMS’s New AI-Powered Prior Authorization System: Will It Speed Up Approvals or Deny Seniors Critical Care?

For years, seniors and doctors have complained that prior authorization delays can feel like a second illness layered on top of an existing medical problem....

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kffhealthnews.org /3 weeks ago

Medicare’s AI Push Snarls Patients and Doctors in Errors and Delays

Medicare is testing the use of artificial intelligence to preapprove several healthcare services. Federal health officials say prior authorization can help reduce fraud and contain...

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fiercehealthcare.com /1 month ago

Anomaly Insights launches AI solution for managed care executives

The Manage platform examines all claims across every payer in a health system’s contract, identifying behavior patterns and synthesizing complex data.

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medcitynews.com /3 days ago

Prior Authorization is a Fight and AI Won’t End It — Stop Pretending Otherwise

The honest question is not whether AI will end the fight. It will not. The honest question is what AI does to a fight that has been structurally imbalanced for 30 years. The post P...

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newswire.com /1 month ago

eviCore by Evernorth Rated #1 as Prior Authorization Becomes a Top Health Plan Technology Acquisition Priority

Q2 2026 Black Book payer IT client scores recognize top performance in PA workflow control, UM execution, medical-policy governance, clinical decision support and 2027 readiness

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fiercehealthcare.com /3 weeks ago

Infinitus launches risk detection system to ensure appropriate patient triage from AI agents

The solution—dubbed Clinical Escalations—continuously assesses risk during interactions, allowing reclassification of events to emergent clinical situations.

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wcpo.com /1 week ago

Is AI ready to take over your prescriptions? Some doctors are wary

A prescription refill program that quietly launched in Utah earlier this year has kicked off a big medical debate: Is artificial intelligence ready to take over tasks that, until n...

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prweb.com /4 weeks ago

Inovaare Expands AI-Native BPaaS for U.S. Health Plans, Defining the Third Generation of Payer Operations

Single-vendor model directly operates Member Services, Appeals and Grievances, and Provider Disputes on one AI-powered platform with one accountable services team, closing the oper...

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fastcompany.com /1 week ago

Can AI fill prescriptions? Here’s what doctors think of Utah’s refill program

A prescription refill program that quietly launched in Utah earlier this year has kicked off a big medical debate: Is artificial intelligence ready to take over tasks that, until n...

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legaltechdaily.com /1 month ago

How to choose an AI solution for healthcare operations

Administrative work is eating into the time healthcare teams have for patients. Tasks like scheduling, documentation, billing follow-ups, and prior authorizations are an everyday p...

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fiercehealthcare.com /2 weeks ago

Zelis rolls out AI solution to help payers navigate No Surprises Act dispute process

Healthcare technology company Zelis rolled out an AI-native solution to help health plans manage Independent Dispute Resolution complexity under the No Surprises Act.

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healio.com /3 weeks ago

Updates on prior authorization: What’s changed and will it make a difference?

Last year, HHS and dozens of health insurers announced an industry pledge to streamline and reduce prior authorization.According to America’s Health Insurance Plans (AHIP), that pl...

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healthcareittoday.com /1 month ago

How a CMS Proposed Rule Would Bridge the Divide Between EHRs and Payers on Electronic Prior Authorization

The following is a guest article by Tyler Wince, VP of Product & Technology for Specialty Solutions at DrFirst. This article is the next in the Healthcare Regulatory Talk seri...

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fiercehealthcare.com /4 weeks ago

Why It’s Time to Sunset AI Point Solutions and Consolidate Platforms

While AI spending in healthcare nearly tripled to $1.4 billion in 2025, a typical health system coordinates dozens of distinct vendors for AI and automation solutions, ranging fr...

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techround.co.uk /2 weeks ago

AI Is Quietly Influencing What Care Gets Approved – Should Patients Be Told?

When a health insurer denies a claim or declines to authorise a procedure, the decision arrives as a letter or... The post AI Is Quietly Influencing What Care Gets Approved – Shoul...

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natlawreview.com /1 week ago

Additional States Continue Legislative Trend with New Laws Limiting Use of Artificial Intelligence in Health Insurance D...

Over the last few years, state legislatures have begun to consider, and ultimately enact, laws governing the use of artificial intelligence (“AI”) in health insurance determination...

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prunderground.com /2 weeks ago

Incredable Launches AI Document Extractor to Automate Provider Credentialing and Verification

New AI capability reads, extracts, and verifies provider credentialing data automatically. The post Incredable Launches AI Document Extractor to Automate Provider Credentialing and...

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natlawreview.com /2 weeks ago

Is the WISeR Prior Authorization Pilot Dead or Alive?

The House Appropriations Committee voted to effectively defund the Wasteful and Inappropriate Service Reduction (WISeR) prior authorization pilot, a program that has faced bipartis...

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fiercehealthcare.com /2 weeks ago

Evernorth unveils new AI-powered specialty pharmacy program, Pharmacy Forward

Evernorth has unveiled a new specialty pharmacy program that leans on AI to support a better experience for patients with complex conditions.

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fiercehealthcare.com /1 week ago

OpenEvidence launches medical AI copilot feature that grades medical evidence and unveils NewYork-Presbyterian collabora...

OpenEvidence developed a medical AI copilot feature that provides a real-time assessment of the strength of the evidence behind each applicable answer.

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insurancebusinessmag.com /3 weeks ago

AI is making health insurance fraud faster, cheaper and harder to detect

Health insurers ramp up AI defenses as synthetic fraud threat escalates

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bioengineer.org /1 month ago

Prior Authorization Criteria Differ Significantly Across Leading Commercial Insurers

In the ever-complex landscape of healthcare administration, one of the most confounding challenges faced by clinicians and patients alike is the variability in prior authorization...

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medcitynews.com /1 month ago

Elevance Health’s 3 Key Priorities for AI

Elevance Health is leveraging AI for simplifying the member experience, improving the provider experience and making sure employees have the right information at the right time. Th...

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medinform.jmir.org /2 weeks ago

Selecting, Scaling, and Measuring the Value of Ambient AI in a Nonacademic Health System: Multiphase Pilot Study

Background: Most US health systems operate on a local or regional scale and face substantial financial and staffing pressures, which are intensified by challenges related to physic...

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