AI Can Ease Prior Authorization Burdens if Used Responsibly

As health insurers promise to streamline prior authorizations by embracing digital tools and automation, some experts are urging caution—especially when artificial intelligence is involved.

For Hari Prasad, CEO of Yosi Health, the potential for AI to improve efficiency is real, but so are the risks if not implemented carefully.

Founded in 2015, Yosi Health’s mission has been focused on reducing the administrative burden that keeps physicians away from patients. The company’s work aligns with insurers’ latest pledge to simplify prior authorization through digitization and real-time approvals.

Prasad shared in a conversation with Managed Healthcare Executive that AI must be deployed in a way that supports, not weakens, clinical care.

“There’s a lot of hype around AI, but there’s also a lot of proven success when it’s used well and when it's used for addressing certain key challenges we face within healthcare,” Prasad said. “In this case—because some of the administrative processes could be handled by AI better—we believe there's a net positive outcome in utilizing AI to improve the process, but at the same time, we also have to recognize that this is new.”

He noted that AI can help handle repetitive administrative tasks, freeing up staff and providers for more meaningful work. But without strong checks in place, the use of AI could lead to rushed decisions or inappropriate denials of care.

Prasad stressed that AI tools should not operate in isolation. Human oversight is key, especially as the technology continues to evolve. He added that health systems must track outcomes to ensure AI tools are delivering as intended.

“At the end of the day, behind every one of these decisions is a patient, there is a family, there’s medical outcomes,” Prasad said. “So it’s very important for us to make sure that any decisions made by AI is looked at and is approved and validated before it ends up adversely impacting a patient.”