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From Administrative Drain to Clinical Gain: The Case for Agentic AI in Prior Authorization for Healthcare Providers

Publisher IDC
Published Jun 27, 2025
Length 12 Pages
SKU # IDC20145627

Description

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."

Table of Contents

12 Pages

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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