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The Long Run Advantages of AI for Prior Authorizations

Artificial Intelligence (AI) lends itself to learning; over time, AI will continue to improve in efficiency, making AI an excellent investment in the long run, especially for the changing world of Prior Authorizations.


Over time, outcomes produced by AI will become more reliable and AI will require less oversight as it continues to learn. We’ve discussed previously how AI differs from traditional decision tree algorithms, and this is one of the key differences; while traditional decision trees remain static in nature, requiring the same amount of resources and producing similar levels of results, AI continues to learn and improve its processes in order to produce better results requiring less oversight.


Building AI engines now is important, as the more the AI learns, the more efficient it will become, and the earlier these AI engines are developed, the sooner we will have access to more accurate and effective AI solutions for use in aiding Prior Authorizations.


How does AI become more efficient over time?

As AI begins to learn and encounters more and more examples, it will begin to shift over from working similarly to data-heavy bottom-up style processing to something more akin to top-down reasoning, which more closely resembles how humans approach problems. Instead of using data and information input to individually devise meaning in order to produce outcomes, AI will begin to be able to use patterns, schemas, and connections to even more efficiently make sense of data and produce outcomes. Consider that instead of asking itself “What is this?”, AI will be able to ask, “Is this like something I’ve seen before?” and proceed from here.


Being able to rely on a previously constructed base of knowledge means that AI will be able to operate much faster. Having more knowledge and information means that AI will be able to learn and adapt, and will be able to construct schemas, patterns that categorize information and the relationships among them. In addition to requiring less oversight, this will also allow for faster identification over time.


This is very applicable for Banjo Health’s Virtuoso AI, which extracts clinical information from Prior Authorization requests, compares the clinical data and information against the payer’s clinical criteria, and presents with justification whether the request should be approved or denied. The more Prior Authorizations Virtuoso processes, the more it will be able to learn, adapt, and improve.


One of Virtuoso’s key strengths is its ability to transcend simple decision support and present justifications for approval or denial, which helps to provide transparency to the Prior Authorization process, one of Banjo Health’s essential goals. The fact that Virtuoso has the potential to adapt and improve on itself over time means that its decision support and explanations will only continue to improve.

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