Highmark Health & Abridge Collaborate on AI-Driven Prior Authorization Solution

The partnership intends to integrate Abridge's ambient clinical documentation technology across Highmark’s health system, including its 14 hospitals and numerous clinics.

Highmark Health is collaborating with Abridge to implement an artificial intelligence (AI) solution designed to automate prior authorization processes at the point of care in real time.

The partnership intends to integrate Abridge's ambient clinical documentation technology across Highmark’s health system, including its 14 hospitals and numerous clinics.

Richard Clarke, Ph.D., Chief Analytics Officer at Highmark Health, said, "We're designing this in a way that we expect it to scale, both in terms of other payers at Allegheny Health Network and other providers beyond that." He emphasized that the focus is on building scalable infrastructure beyond the current scope.

The AI-powered tool by Abridge converts patient-clinician conversations into structured clinical notes, integrated directly with electronic health records (EHR). The technology has already been piloted in outpatient settings and is expected to expand to emergency departments, hospitalist programs, and home care.

Abridge CEO Shiv Rao, M.D., highlighted the uniqueness of the collaboration, stating, "Highmark Health and AHN represent something quite rare in the industry. They are incredibly creative and innovative payer-providers, and their innovations span many different areas but include prior authorization." He added that working with Highmark allows Abridge to "apply AI into these workflows to augment them further."

The prior authorization tool automates tasks such as form completion, request submission, status tracking, and identification of authorization requirements. It acts as a real-time checklist for clinicians, who retain complete control over reviewing and approving AI-generated recommendations before submission.

The goal is to reduce administrative burdens on clinicians and health system staff while accelerating patient access to necessary care. "The future vision is a tool that allows clinicians to push through patient medical procedures and medications at the point of care," the organizations said.

Physicians currently face a significant administrative load related to prior authorizations. A 2024 American Medical Association survey found that on average, doctors complete 39 prior authorization requests weekly, spending approximately 13 hours on these tasks.

Clarke noted that Highmark has previously improved prior authorization speed through programs such as its Gold Carding initiative, which expedites approvals for clinicians following evidence-based guidelines. "We've made tons of progress on improving the speed of approvals and improving the overall experience, both for clinicians and for members and patients, but we saw what Abridge was working on allowed us to take that to the next level," he said.

The collaboration will begin testing with specific procedures within specialties to ensure accuracy before broader implementation. Clarke added, "We are the ideal candidate to figure this out because it does require iteration. One of the biggest things that you need with iteration is trust."

Both Highmark and Abridge aim to use AI as a collaborative bridge between payers and providers rather than a competitive tool. Rao said, "Our work with Highmark and AHN demonstrates that AI technology doesn't need to be an arms race... How do we improve the clinician experience? And, most importantly, how do we improve the experience and outcomes for their patients?"

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