AI and health insurance prior authorization: Regulators need to step up oversight

AI and health insurance prior authorization: Regulators need to step up oversight
Health Affairs; by Carmel Shachar Amy Killelea Sara Gerke; 7/24
Artificial intelligence (AI)—a machine or computer’s ability to perform cognitive functions—is quickly changing many facets of American life, including how we interact with health insurance. AI is increasingly being used by health insurers to automate a host of functions, including processing prior authorization (PA) requests, managing other plan utilization management techniques, and adjudicating claims. In contrast to the Food and Drug Administration’s (FDA’s) increasing attention to algorithms used to guide clinical decision making, there is relatively little state or federal oversight of both the development and use of algorithms by health insurers.