At Anthem Blue Cross and Anthem Blue Cross and Blue Shield, we are deeply committed to ensuring our members receive safe, high-quality, evidence-based, clinically appropriate care. Prior authorization is a key part of this commitment. Prior authorization helps ensure that patients receive care and medications that are based on scientific evidence, aligned with medical policy, and that they’re not receiving or paying for services or treatments they don’t need.
Along with the Blue Cross Blue Shield Association and AHIP, we are announcing commitments regarding prior authorization processes to connect patients to the right care faster and reduce administrative burdens on care providers.
Accelerating decisions
We are leveraging advanced technology, including artificial intelligence (AI), to speed up prior authorization approvals, which in turn reduces delays in care. This also reduces administrative burdens on providers, allowing them more time to care for their patients. Importantly, we do not and will not use AI to make prior authorization denial decisions. Denial decisions are only made by licensed clinicians.
Simplifying processes
To make care providers’ experience with us easier, more efficient and effective, we are simplifying, streamlining, and automating time-consuming processes, making it quicker and more convenient for care providers to interact with us.
As an example, we have gold card programs where high performing medical groups in value-based care arrangements have hundreds of outpatient PA requirements waived or bypassed. We are now expanding these efforts.
Commitment to responsible use of AI
Our use of AI with prior authorization focuses on speeding up approvals and reducing administrative burdens, and we follow strict ethical guidelines and comply with all state and federal laws to ensure privacy and security. We are committed to responsible, ethical technology use to enhance healthcare outcomes while maintaining transparency and patient trust.
We look forward to sharing more updates on our work to build a more transparent, responsive health system that better serves the needs of patients and care providers alike.