Insurers Vow to Speed Up Prior Authorizations with AI and New Data Standards

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Insurers have faced long-standing pressure to simplify and speed up coverage screening requests for services like CAT scans and specialty drugs. Addressing this, multiple insurers presented improvement strategies at a meeting of the National Association of Insurance Commissioners' Regulatory Framework Task Force. A key proposal is the mandatory use of the Fast Healthcare Interoperability Resources (FHIR) data-sharing format across all plans. This standardization is expected to streamline the approval process. AI is also planned for implementation, intended to facilitate quicker approvals. However, AHIP members stressed that AI will only assist in quick approvals and will not be used for denials based on medical necessity without a clinician's review. Conversely, patient advocacy groups questioned the realism of these promises, stating they largely repeat existing obligations and noting the lack of participation from consumers or provider associations in shaping them. Furthermore, AHIP data highlighted that significant obstacles remain, as 47% of prescription prior authorization requests and 45% of medical services requests are still submitted via non-standard methods (phone, mail, fax) rather than electronic systems. These efforts underscore the global push for standardized data exchange and efficiency in healthcare IT, mirroring the importance of standards like FHIR in Japan's healthcare sector.