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The changing face of prior authorizations

Published by HCL Technologies

Prior authorization (PA) is a critical but administratively burdensome healthcare process, often delaying care due to manual workflows and fragmented data systems. The CMS proposed regulations to streamline PA by mandating electronic data exchange (FHIR) and faster approval timelines by 2026. AI, machine learning (ML), and generative AI (GenAI) are modernizing PA by automating document digitization, clinical decision-making, fraud detection, and real-time monitoring. Integrated workflow solutions, analytics, and payer-provider collaboration enhance efficiency, reducing costs and improving patient care while ensuring compliance with evolving healthcare regulations.

 

 

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Related Categories Analytics, Data Analytics, Machine Learning, Artificial Intelligence, Generative AI, Cognitive Computing, AI in Business, AI in Healthcare, Sentiment Analysis, Text Mining, Speech Recognition, Machine Translation, Language Models

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