PUBLISHER: IDC | PRODUCT CODE: 1758281
PUBLISHER: IDC | PRODUCT CODE: 1758281
From Administrative Drain to Clinical Gain: The Case for Agentic AI in Prior Authorization for Healthcare Providers
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
Learn More
- Related Research
- Synopsis
