Prior authorizations (PA) remain a largely manual and inefficient process, placing heavy burdens on providers and payers. Despite CMS mandates for electronic standards and upcoming FHIR requirements by 2026, adoption remains low, with only 21% of transactions fully electronic. The shift to value-based care, growing healthcare demands, and regulatory changes underscore the need for streamlined PA. HCLTech proposes a modernized, AI-enabled approach that includes automated workflows, real-time data sharing, interoperability, and member-centric design. AI, ML, and GenAI enhance decision-making, fraud detection, and communication—driving efficiency, accuracy, and better care access.

Join for free to read