How Health Care Service Corp. made prior authorization 1,400 times faster with AI

Health Care Service Corporation, which operates Blue Cross Blue Shield affiliates in Illinois, Texas, Oklahoma, Montana and New Mexico, is expanding AI technology to speed up prior authorization. 

In a July 13 news release, the company said it expanded the use of its AI technology, which can make the prior authorization process up to 1,400 times faster, to inpatient acute care, long-term acute care, inpatient rehabilitation, skilled nursing care, outpatient and inpatient hospice care, home health and outpatient services.  

The system delivers approvals "almost instantaneously." HCSC piloted the program in behavioral health and specialty pharmacy. The system approved 80 percent of behavioral health requests and 66 percent of specialty pharmacy requests. 

No requests are denied using the system, the company said in the news release. They are either approved or sent to HCSC clinicians for further review. 

The company has also eliminated prior authorization requirements for over 1,000 procedure codes since 2018. 

"We recognized a few years ago the need to make it quicker and easier for providers and members to get the answers they need and took advantage of emerging technology to develop a suite of tools that simply work better for everyone involved," Monica Berner, MD, HCSC's chief clinical officer, said in the release. 

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