Google unveils AI technology to streamline prior authorization

Key takeaways:

• Google said its technology will ease administrative burdens while enhancing patient care.
• The AI-enabled suite is now available to Google Cloud customers; more features will become available later this year.

Google Cloud has unveiled an artificial intelligence-enabled Claims Acceleration Suite that will help streamline prior authorization and claims processing, the company announced in a press release.

The suite uses software from Google’s Claims Data Activator to convert unstructured data into structured data, allowing insurers to make faster decisions and improve patient care, according to the release. It also utilizes several analytical reporting tools for machine learning and data visualization.

The AI-enabled prior authorization is now available for Google Cloud customers, and other features of the suite will become available later in the year, the company said.

Blue Shield of California has piloted the technology. The company is in the final stages of testing, Lisa Davis, Blue Shield of California's senior vice president and chief information officer, told Healio.

“Our goal is for Google’s artificial intelligence and machine learning technologies to reduce manual intake and data entry for Blue Shield, so we spend more time reviewing clinical documentation from providers — this often comes to us via fax and is converted into PDFs — and on making prior authorization decisions,” Davis said.

The technology, she added, will help the company “ingest, standardize and normalize information shared by provider partners (whether by fax or electronically) in the way that works best for them.”

“Exchanging data in this way will help cut down on administrative processes so providers can spend more time with their patients,” she said. “Our intent is to increase and accelerate access to care for our members by streamlining processes, so providers spend very little time on prior authorization and so that we deliver approved decisions back in near real-time.”

According to Google, the suite will help health plans meet current and proposed requirements for prior authorization made by CMS, which include the implementation of Health Level 7 Fast Healthcare Interoperability Resources standard application programing interface.

Google Cloud also partnered with software companies Myndshft and Pegasystems for the program’s prior authorization submission process, enabling it to calculate out-of-pocket costs while checking for missing information and conducting status monitoring.

Speaking to Healio, Deepti Pandita, MD, FACP, FAMIA, the chief medical information officer at the University of California, Irvine Health System, said the technology “will help decrease the time and resources health care systems spend on getting prior authorizations, which often results in safety issues due to delays in treatment.”

However, Pandita also noted that “the algorithms behind the AI-enabled suite are not published and proprietary to Google.”

“It is unclear what data was used to design it; this always raises concerns if the platform is equitable and if there could be any ethical concerns,” she said.