Regulation of AI in Healthcare Utilization Management and Prior Authorization Increases

In this article:

• Over the past two years, federal and state government agencies have moved to regulate the deployment of artificial intelligence (AI) in the healthcare setting, including in utilization management (UM) and prior authorization (PA) processes used to determine insurance coverage for medically necessary healthcare items and services.
• This Holland & Knight alert provides a summary of these efforts to regulate the use of AI in UM and PA, as well as recommendations for key stakeholders, including managed care plans and UM organizations, to help ensure they remain compliant within this constantly shifting regulatory landscape.