Automation in the Prior Authorization Process: Findings

Recent years have seen growth in the use of technology, including artificial intelligence, to automate parts
of the Medicaid prior authorization process. However, there is little information available today about how
automation is used in Medicaid prior authorization and its impact on payers, providers, and Medicaid
beneficiaries. To fill this gap in knowledge, MACPAC conducted a literature review, a federal policy
review, and stakeholder interviews on the role of automation in the Medicaid prior authorization process.
During this session, we summarized the findings from this project, including how states and managed
care organizations (MCOs) use automation in prior authorization; the extent of federal and state
oversight, guidance, and regulation of automation in prior authorization; potential risks posed by
automation in prior authorization; and the impact of the existing regulatory environment on states’ and
MCOs’ adoption of automation.