This IDC Perspective explores how healthcare providers can radically streamline one of their most burdensome administrative processes, prior authorization (PA), through agentic AI. The document details the operational inefficiencies of legacy PA workflows, examines why traditional automation has failed to deliver transformative value, and outlines how agentic AI platforms offer real-time, data-driven orchestration across clinical, payer, and administrative systems. With insights from IDC data and real-world deployments, it presents PA as the ideal launchpad for scalable AI in healthcare."Agentic AI isn't just streamlining prior authorization; it's turning it inside out," says Mutaz Shegewi, senior research director, Worldwide Healthcare Provider Platforms and Technologies, IDC. "This is no longer about automation or efficiency. It's about turning a notorious bottleneck into a strategic engine for speed, scale, and clinical impact, finally, and for a change."
Executive Snapshot
Situation Overview
Why Agentic AI in Prior Authorization Matters
The Innovation–Experience Gap
Administrative Burden
The Contextual Complexity of Healthcare Data
A Paradigm Shift in Process Design
Human-Centered Autonomy
A Strategic Framework for Agentic AI in Prior Authorization
Complexity: High-Variance, High-Friction Workflows
Accuracy: Enabling Oversight, Compliance, and Trust
Speed: Compressing Multistep, Multi-Stakeholder Workflows
Strategic Signals: Why the Market Is Moving Toward Agentic AI in Prior Authorization
Composable Architectures: Built for Scale, Designed for Change
Life-Cycle Economics: Rethinking the Cost Curve
Strategic Drivers of Agentic AI for Prior Authorization
Vendor Landscape: Mapping the Agentic AI Ecosystem in Prior Authorization
Document Intelligence and Front-Office Automation Agents
Multi-Agent Orchestration Solutions
Conversational and Voice-Based Agents
Clinical Alignment and Utilization Management Agents
Mapping the AI Agent Use Case: Prior Authorization for Healthcare Providers
Advice for the Technology Buyer
Operationalize Data Liquidity; Do Not Just Integrate
Design for Controlled Autonomy, Now
Start Where Complexity Meets Volume
Demand More Than "AI Enabled," Vet for True Agentic Depth
Bridge to the Patient and Clinician Experience
Parting Thoughts: Agentic AI Is a Systemic Shift, Not an Upgrade
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