From Weeks to Minutes: Al Tackles Prior Approval

Highmark and Abridge are piloting Al that files prior authorizations during visits at AHN clinics.

19 Aug 2025

Highmark Health has launched a pilot programme with Abridge to test an artificial intelligence tool designed to streamline prior authorizations at Allegheny Health Network's outpatient clinics, with plans to expand across the system.

Prior authorization, the process by which insurers approve treatments before they are delivered, has long been criticised for delaying care and adding costs. The American Medical Association estimates the process costs the US healthcare system about $35bn annually.

Highmark has previously introduced measures to accelerate approvals, including its "Gold Card" programme, which grants automatic clearance to clinicians who follow evidence-based guidelines. The insurer has also invested in the Availity provider portal and its Predictal Auth Automation Hub to cut paperwork and reduce turnaround times.

The new tool differs by operating during the patient visit. It uses ambient Al to capture relevant clinical information, auto-generate an authorization request, submit it, and track status, often before the consultation ends.

"Highmark Health and AHN represent something quite rare in the industry; they are actually one of the few entities across the country who have innovated and revolutionized what prior authorization today looks and feels like for clinicians across their whole system," said Shiv Rao, chief executive of Abridge.

Richard Clarke, chief analytics officer at Highmark, said beginning with outpatient visits "allows us to design for scale across payers and providers and build on our existing infrastructure."

The initiative reflects a wider industry push toward automation and transparency in prior authorization. US regulators have been pressing health plans to speed approvals and reduce paperwork, while insurers and technology firms are investing in systems that lessen administrative burden.

If successful, Highmark's pilot could provide a model for embedding real-time automation into routine clinical care, reducing delays and improving patient access to treatments.