In a 2021 Medical Group Management Association (MGMA) survey, 88 percent of respondents described prior authorization requirements as very or extremely burdensome. In an attempt to alleviate this issue, Florida Blue, the Blue Cross and Blue Shield plan of Florida, said it is becoming the first U.S. payer to automate the prior authorization approval through AI-powered clinical reviews.
Prior authorization process is a time-consuming endeavor for both providers and payers, usually requiring phone calls and faxes to provide patient medical records. Incomplete and inconsistent data can cause delays and lead to a 15-day cycle before a member receives authorization for a procedure. Florida Blue receives hundreds of thousands of prior authorization submissions each year.
Deploying an AI platform from a company called Olive shifts the prior authorization decision-making to the point of care (such as a doctor’s office), Florida Blue said. The solution will enable members to receive authorizations faster by giving providers an immediate approval from Florida Blue (sometimes before a member leaves their provider’s office) when Olive’s artificial intelligence determines the prior authorization request meets Florida Blue’s medical necessity requirements.
Florida Blue said it launched a pilot with Olive last year and saw impressive results: a massive reduction in time to decision by 10 days when immediate responses were available and a 27 percent decrease in unnecessary prior authorization requests, lessening the provider's burden and operational costs and 48 percent faster decisions leading to faster patient care.
"Olive’s AI platform helps Florida Blue create a best-in-class utilization management model that reduces the administrative burden on our providers while creating a better experience for our members," said Elana Schrader, M.D., Florida Blue senior vice president, healthcare services and GuideWell Health president, in a statement. "By being the first health plan to automate approvals, we are leading the way for insurers to close the technology gap to better serve our members and providers.”
