Abridge partners with Availity for AI-powered prior authorizations

Healthcare AI company Abridge and Availity announced a new partnership aimed at making prior authorizations easier.

Prior authorizations are one of the most significant pain points in healthcare, leading to excessive administrative burden and adverse clinical outcomes. However, AI could be poised to make the process faster and more effective for both payers and providers.

Abridge will apply its enterprise-grade AI platform, which over 200 health systems already use, to Availity's Intelligent Utilization Management solution, formerly known as AuthAI. Availity highlights the solution's interoperable design using Fast Healthcare Interoperability Resources, or FHIR, standards and real-time recommendations, which are based on a health plan's medical criteria. Availity itself connects with over 95% of payers, as well as more than 3 million providers and 2,000 trading partners.

Through the partnership, Abridge will integrate its Contextual Reasoning Engine technology into Availity's solution, enabling clinicians to access relevant clinical information during patient encounters and supporting documentation for prior authorization requests.

The companies said that the partnership will establish "real-time bridges" between payers, providers, and patients, resulting in a more efficient prior authorization process.

"By embedding our technology at the point of conversation, we're enabling faster, more transparent utilization management decisions rooted in clinical context," Russ Thomas, CEO of Availity, said in the announcement. "We're excited to collaborate with Abridge and to demonstrate what's possible when payer intelligence meets real-time provider workflows."

Alignment between payer and provider workflow is at the heart of the partnership. The companies emphasized that the application of real-time conversational intelligence will simplify the prior authorization process by supporting the ultimate goal of enabling payer determinations during a patient's visit.

The new AI capabilities will also be able to highlight documentation gaps during a provider's conversation, supporting complete and clinically accurate documentation. These notes are the basis for prior authorization requests, and payers use them to issue approvals or denials.

Overall, Abridge and Availity aim to reduce the administrative burden of prior authorizations and return the patient to the center of clinical conversations.

“Abridge and Availity are each bringing national scale, deep trust, and a track record of solving important challenges across the care and claims experience to this partnership,” said Shiv Rao, M.D., CEO and co-Founder of Abridge.

Abridge has established its name by developing AI-powered clinical documentation tools, but has recently expanded into the prior authorization technology space. The company teamed up with Highmark Health in August to codesign an AI-powered prior authorization solution at the point of care. The solution also leverages Abridge's expertise in AI medical scribe technology to facilitate real-time prior authorization decisions.

Jacqueline LaPointe is a graduate of Brandeis University and King's College London. She has been writing about healthcare finance and revenue cycle management since 2016.