Agentic AI for Prior Authorization: From Administrative Burden to an Interoperable, Auditable Operations Fabric

Prior Authorization has become one of the most significant operational bottlenecks in healthcare—driving delays, denials, and administrative strain. Traditional automation has failed to solve the problem, leaving stakeholders stuck in fragmented, inefficient workflows.

This whitepaper introduces an agentic AI-driven approach—leveraging coordinated AI agents to transform prior authorization into a faster, intelligent, and auditable process. It outlines how organizations can move from rigid, rules-based systems to adaptive, interoperable workflows that improve outcomes, reduce burden, and enhance compliance.