Optum rolls out AI-powered prior authorization to cut delays and administrative waste
Optum is introducing AI-driven prior authorization that aims to deliver faster, more consistent decisions and reduce repetitive work for providers. Allina Health, a nonprofit system with 12 hospitals in Minneapolis-St. Paul, will be among the first to deploy it.
For finance and care leaders, the pitch is simple: fewer manual touches, shorter review cycles, and cleaner first-pass approvals. That translates to lower operating cost, fewer avoidable denials, and quicker access to care.
Why this matters
- 45% fewer manual touches
- 56% reduction in review time
- 80% improvement in documentation bundling efficiency
- 96% first-pass approval rate
If these results hold at scale, expect measurable gains in revenue cycle velocity and staff capacity. Prior auth turns from a bottleneck into a background process.
How it works
Providers submit requests through Digital Auth Complete by Humata Health. The AI compiles required clinical materials, applies payer rules, and submits authorizations automatically. Features can embed directly into the EHR to keep clinicians in their normal workflow.
Payers can process authorizations using InterQual Auth Accelerator. Optum said the same AI capabilities used for real-time authorization decisions are being extended to broader clinical and administrative use cases.
What leaders are saying
"We're transforming the prior authorization process to address the friction it causes," said Dr. John Kontor, senior vice president of clinical technology at Optum Insight. "By uniting clinical data, evidence-based criteria, and human-centered AI at every step, we're making it simpler and faster for patients to get appropriate care."
"With Optum, our goal is to make prior authorization virtually invisible to providers and patients," said Dr. Jeremy Friese, CEO of Humata Health. "By embedding real-time approvals and AI-driven automation into clinical workflows, we're reducing administrative burden and helping patients get timely care."
Regulatory backdrop
Major health plans have committed to simplifying prior authorization. The Centers for Medicare & Medicaid Services now requires faster turnaround: urgent requests within 72 hours and standard requests within seven days, effective January 1.
Details are available from CMS here: Advancing Interoperability and Improving Prior Authorization Processes.
Finance and operations impact
- Operating expense: Fewer manual reviews reduce labor hours in utilization management and rev cycle teams.
- Cash flow: Faster approvals shorten time-to-schedule and time-to-bill, improving DSO and working capital.
- Denial prevention: Cleaner first-pass decisions lower downstream rework and write-offs tied to authorization errors.
- Capacity: Clinician time shifts from paperwork to patient care, supporting throughput without equivalent headcount growth.
Implementation checklist
- Define governance: Clinical, IT, rev cycle, and compliance alignment on scope, auditability, and escalation paths.
- EHR integration: Embed request generation and document bundling at the point of order to avoid swivel-chair tasks.
- Data quality: Standardize problem lists, order sets, and clinical notes to feed consistent evidence into the model.
- Payer rules: Maintain a current rules library and monitor variance across lines of business.
- Controls: Establish audit logs, explainability thresholds, and periodic sampling for accuracy and equity.
- Security: Validate PHI handling, encryption, vendor risk, and BAAs.
- Change management: Train clinicians and UM staff on new workflows; set clear SLAs and escalation criteria.
KPIs to watch
- First-pass approval rate and turnaround time (urgent vs. standard)
- Manual touch rate per request and staff hours per authorization
- Denial rate due to authorization and associated write-offs
- Schedule lag from order to appointment and impact on revenue capture
Early adopters
Allina Health will be among the first to deploy the new solution. Watch for benchmarks from its rollout to validate performance across service lines with high prior auth volume (imaging, cardiology, orthopedics, specialty drugs).
Bottom line
AI-driven prior authorization is moving from pilot to production. If you run finance, rev cycle, or clinical operations, this is a practical lever for cost containment and access-to-care gains-provided you lock down data quality, payer rules, and governance.
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