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In a recent survey by revenue cycle management company FinThrive, 73 percent of respondents said they are using AI and automation to streamline prior authorization. To meet this demand from health system customers, vendors such as ambient clinical intelligence company Abridge continue to target improvement of the prior authorization process through partnerships involving its clinical conversation tools.
In 2025 Healthcare Innovation interviewed Pittsburgh-based Highmark Health’s senior vice president and chief analytics officer, Richard Clarke, Ph.D., about how Highmark was deploying Abridge’s ambient clinical documentation platform at its Allegheny Health Network, and also co-developing with Abridge a prior authorization solution at the point of conversation.
Now Abridge has announced it is working on a prior authorization solution with Availity, which runs a real-time health information network connecting health plans and providers to streamline administrative and clinical transactions. The companies say their engagement uses technology grounded in the clinician-patient conversation to facilitate a more efficient process between clinicians and health plans in medical necessity review.
Rather than creating parallel AI systems across healthcare stakeholders, Abridge and Availity say they are working together to ensure shared clinical context at the point of conversation powers administrative processes, such as prior authorization review and submission, with the goal of improving outcomes for patients and the teams delivering care.
Abridge’s AI platform serves more than 200 health systems and is projected to support over 80 million patient-clinician conversations in 2026. Availity says its FHIR-native APIs enable fast, scalable, and secure connectivity of payer information across the entire healthcare ecosystem. With Abridge’s Contextual Reasoning Engine technology, clinicians can gain visibility into relevant clinical information during the conversation to support documentation aligned with prior authorization requirements.
“By embedding our technology at the point of conversation, we’re enabling faster, more transparent utilization management decisions rooted in clinical context," said Russ Thomas, CEO of Availity, in a statement. “We’re excited to collaborate with Abridge and to demonstrate what’s possible when payer intelligence meets real-time provider workflows.”
The development of real-time prior authorization is just one component of a broader revenue cycle collaboration that is focused on applying real-time conversational intelligence across the patient, provider, and payer experiences. The companies intend to support integration by collaborating on workflow alignment between their respective platforms in the following areas:
• Simplified Prior Authorization: Aligning utilization management and order submission within the conversation, with the goal of enabling payer determination during the visit
• Documentation Gap Visibility: Highlighting documentation gaps during the conversation—not after—to support high quality, compliant, and clinically accurate documentation that is representative of the patient’s current condition
• Authorization Integrity: Supporting more complete and accurate documentation at the point of conversation reduces downstream administrative cycles between payers and providers and keeps the needs of the patient at the center of the request
• Reduced Administrative Burden: By supporting clinicians with prior authorization documentation and submission during a visit, the goal is to help both payers and providers reduce manual workflows, administrative delays, and other time- and resource-intensive needs, such as peer-to-peer consults
At Highmark, Clarke explained that Abridge’s ambient clinical intelligence is being used to reduce documentation burden for clinicians at the point of care. “But we're also talking about how it can reduce friction between payer and provider. The first step will be in the prior authorization work that we're doing together, but we see many more opportunities in the future to bring payer-related insights into workflow to improve health outcomes and create more affordable care.”
The first phase of the collaboration involves implementing Abridge’s ambient clinical intelligence platform at Allegheny Health Network’s office locations and hospitals.
Highmark explained that until now, most attempts at solving the challenges of prior authorization have focused on streamlining the approval process post-encounter, but in this solution the authorization process will now happen at the point of conversation.
Abridge’s AI solution automates tasks such as completing forms, submitting and reviewing requests, tracking their status, and identifying when prior authorization is needed in the first place. Clinicians remain at the helm of the process, reviewing all AI-generated recommendations before anything is submitted, and will be able to understand in real-time whether they have inadequate evidence for a prior authorization, Highmark said.
This partnership will build on Highmark’s earlier efforts around prior authorization, Clarke stressed. “We’ve been focused very intently on continuing to improve that experience. We've been doing that with both Allegheny Health Network as well as other provider partners through our active “gold carding” program,” he said. “We’re not just gold carding providers based on their historic performance, but also actively working with providers help them understand what requirements they might be missing, to help them get to some of those thresholds to become gold card. Because we've been doing all that work, we were really well positioned to partner with Abridge. We said let's take the natural next step to bring that into the actual conversation between clinician and patient at the point of care.”
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