Track Chair: Kathy Malas

Patients suffer when transitions of care, important medications and urgent surgeries are delayed due to the excessive human- and fax-centric prior authorization processes required by Payors. Furthermore, payors frequently change their prior authorization rules without proper notification burdening the provider with manually updating their prior authorization rule engines. Northwell has partnered with Ascertain to build out a fully-automated process for prior authorizations using a proprietary Generative AI Intelligent Autonomous Agent Framework. These agents can find the current rule set, generate SQL to pull relevant data, QA check that data, write and then submit prior authorizations. Should the prior authorization be denied, these agents can carry on text chats and monitor human medical necessity conversations to extract the latest rules and write those back into the rules engine database for subsequent use.