AI companies are leaning on partnerships for prior authorization

Published in Modern Healthcare featuring Matt Parker, chief product officer at Cohere Health

Overview:‍

Modern Healthcare’s latest feature highlights how ambient AI is evolving from a documentation tool into a powerful solution for improving prior authorization. As health plans work to reduce administrative burden and accelerate care decisions, early adopters are learning that ambient AI is most effective when paired with strong clinical intelligence.

The article showcases how companies like Cohere Health are using ambient AI to extract essential clinical details, streamline medical necessity reviews, and improve decision accuracy. By pairing ambient listening capabilities with deep clinical expertise from nurses and physicians, Cohere Health ensures that AI reduces this burden, strengthens clinical judgment, and supports faster, more consistent decisions.

This emerging approach positions ambient AI prior authorization collaborations as a key driver of improved documentation quality, provider experience, and care delivery.

Key themes covered:

1. Ambient AI is expanding from documentation to prior authorization

• The industry is moving beyond note-taking to real-time identification of medical necessity criteria during patient encounters.
• This shift aims to prevent downstream delays and reduce administrative burden.

2. Strategic partnerships are accelerating innovation

• Collaborations between payers, providers, and AI companies—such as Cohere Health and Microsoft Dragon Copilot's—are essential for building solutions that reflect real-world workflows.
• These partnerships provide access to clinical data and operational insights that shape more effective AI tools.

3. Clinical intelligence is the foundation of effective prior authorization AI

• Parker highlights that AI must understand clinical documentation, policy requirements, and plan rules to deliver safe and consistent decisions.
• Ambient AI can surface the exact information needed for a specific procedure, improving accuracy and reducing unnecessary back-and-forth.

4. AI should support clinical judgment rather than replace it

• Cohere Health’s clinical team plays a central role in training and validating AI behavior.
• Parker notes that the company built a library of practical prompts and strengthened verification tools so nurses remain in control of decisions.

5. Reducing administrative burden remains the core value

• Ambient AI helps eliminate repetitive tasks, improve documentation completeness, and streamline prior authorization workflows.
• The result is less provider abrasion and faster access to care.

6. Ambient AI is beginning to influence broader payer operations

• Beyond prior authorization, ambient intelligence is being explored for care coordination, case management, and real-time claims processing.
• This signals a future where ambient AI becomes a foundational layer across health plan operations.

Read the original article