Optum has launched a pair of AI-driven prior authorization products, one designed to speed up submissions on the provider side and another to accelerate clinical reviews for payers.
The provider-facing product, Digital Auth Complete, went live in January in collaboration with digital health company Humata Health. The payer-facing product, InterQual Auth Accelerator, began piloting with two large health plans in late 2025, with the first payer expected to be fully live by April.
“It’s a combination of three things,” John Kontor, MD, senior vice president of clinical technology at Optum Insight, told Becker’s, explaining why the products are coming to market now. “It is the policy changes, including CMS-0057, that have accelerated everyone’s urgency to get this figured out. Two, it’s the readiness now of technology to be able to support solving many of these administrative, burdensome problems in healthcare. And third, the policy changes really reflect both industry frustration and impatience and the public’s real desire to get real and better answers to the problems of prior authorization.”
Digital Auth Complete embeds AI-enabled authorization features into the EHR to determine when prior auth is needed, gather documentation and submit requests automatically. Minneapolis-based Allina Health will be among the first health systems to deploy the tool.
On the payer side, InterQual Auth Accelerator pairs Optum’s InterQual clinical criteria with AI to digitize payer rules, extract relevant clinical information from provider records and bring it to human reviewers. Most payers using the accelerator are starting with an augmented workflow, where AI organizes and presents information but a human reviewer still makes the determination, rather than fully automated approvals.
“We do not and will not automate denials,” Dr. Kontor said. “This is only accelerating reviews and automating approvals.”
The launches come amid mounting pressure within the insurance industry to overhaul prior authorization. CMS’ interoperability and prior authorization final rule (CMS-0057) requires payers to send prior auth decisions within 72 hours for urgent requests and seven days for standard requests, with requirements taking effect through 2027.
A December survey found that one-third of payers have not started their API requirements ahead of the compliance deadline. Nearly 50 insurers have also pledged to implement a standardized electronic prior authorization process and aim for 80% of electronic approvals in real time by 2027.
Dr. Kontor framed the business case for the new tools as extending beyond regulatory compliance.
“This is not just a friction problem. This is an inefficiency and cost problem for both payers and providers,” he said. “As a country, we are spending billions of dollars every year unnecessarily in this administrative process.”
The prior authorization tools are the latest in a series of AI-enabled products from Optum as the company works to rebuild its health IT business following the 2024 Change Healthcare cyberattack. Recent launches include Optum Real, a real-time claims validation platform, and Crimson AI, a predictive analytics tool for operating room scheduling. UnitedHealth Group has said it has deployed more than 2,000 engineers on AI initiatives and integrated over 1,000 use cases across its business.
