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Blue Shield California is partnering with cloud-based software company Salesforce to automate prior authorization requests, intending to fast-track decisions from days to “near real time,” according to a press release.
Starting in 2025, the pair will test artificial intelligence (AI) technology that can scan a patient’s electronic health record, automatically pull health information that is relevant to a request, then put it into a form that can return a prior authorization decision within minutes, according to the October 21 release. The tech will have a limited rollout later in the year and officially be available in January 2026.
“Prior authorization was never meant to be a barrier or a burden. As a health plan, it’s our responsibility to ensure safe, evidence-based, high-value care for our members, and we know it can be an easier process for everyone,” Paul Markovich, CEO of Blue Shield California, said in the release.
A growing problem. Prior authorization has long been a source of stress for healthcare providers.
Physicians say the process takes an average of 12 hours a week, delays care, hurts patient outcomes, and ends in unjust denials, according to the American Medical Association’s annual 2023 prior authorization physician survey. It also found that 95% of respondents report prior authorization increases burnout.
But automation is a controversial solution.
The Senate Permanent Subcommittee on Investigations released a report on October 17 that pushes for the Centers for Medicare and Medicaid Services to ramp up artificial intelligence (AI) regulation for prior authorization.
The committee noted in the report that while insurers contend that automation technologies will only determine approvals and physicians will still decide final denials, that isn’t always the case.
For example, a 2023 Stat investigation revealed that UnitedHealth Group subsidiary NaviHealth pressured medical staff to defer to its predictive algorithm for care rather than their clinical judgment.
Stat reported that NaviHealth “did not respond directly to Stat’s questions about the use of its algorithm.” Instead, a spokesperson said, “the NaviHealth predict tool is not used to make coverage determinations. The tool is used as a guide to help us inform providers, families, and other caregivers about what sort of assistance and care the patient may need both in the facility and after returning home.”
But Blue Shield California doesn’t anticipate this being a problem because its automated process will only be used for approvals, Markovich told Yahoo Finance.
"We don’t see that being an issue in terms of any kind of machine-driven process denying care," he said.