Generative and agentic artificial intelligence (AI) have the potential to reduce the administrative workload associated with prior authorizations, enhance the accuracy of determinations, and reduce human error. The technology could be trained to mine medical records, clinical documentation, and the health plan’s own criteria to validate evidence of medical necessity and auto-approve requests. AI could also help health plans comply with the new regulations from CMS. Clinical oversight will still be needed.
In a social media landscape shaped by hashtags, algorithms, and viral posts, nurse leaders must decide: Will they let the narrative spiral, or can they adapt and join the conversation?
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