February 4, 2026
Optum is advancing AI-powered digital prior authorization to reshape care delivery
Intelligent automation helps streamline submissions, and speed approvals for a seamless experience for payers, providers and patients.
(Feb. 4, 2026) Prior authorization supports appropriate, evidence-based care, but the process has created delays and administrative complexity. Optum is introducing AI-powered prior authorization solutions to deliver timely decisions that reduce delays and improve access to care. As a leader in utilization management, Optum continues to modernize and reduce friction across the care journey.
Providers can submit requests quickly and accurately with Digital Auth Complete, while payers can make decisions more efficiently and ensure clinical standards are met with InterQual® Auth Accelerator. These solutions help deliver clearer submissions and faster approvals while cutting down on repetitive work across the process.
“We’re transforming the prior authorization process to address the friction it causes,” said John Kontor, M.D. senior vice president of clinical technology at Optum Insight. “By uniting clinical data, evidence-based criteria, and human-centered AI at every step, we’re making it simpler and faster for patients to get appropriate care.”
Automation that speeds submissions for patients and providers
Providers and administrative staff spend an average of 13 hours per week on prior authorization tasks, time that could otherwise support patient care. Digital Auth Complete, powered by Humata Health, embeds AI-enabled authorization features directly into the EHR to ease that burden. Smarter workflows ensure prior authorization happens only when truly necessary, eliminating 45% of manual touches and driving an 80% increase in processing efficiency as the system gathers required materials, applies payer rules and submits requests automatically. This saves time, reduces avoidable denials and streamlines end-to-end processing. Recent Humata Health deployments have achieved a 96% first-pass approval rate, ensuring most requests are approved on the first attempt.
Allina Health, one of the Midwest’s largest health systems and a key co innovation partner of Optum's, will be one of the first to deploy this new solution.
“With Optum, our goal is to make prior authorization virtually invisible to providers and patients,” said Jeremy Friese, MD, CEO of Humata Health. “By embedding real-time approvals and AI-driven automation into clinical workflows, we’re reducing administrative burden and helping patients get timely care.”
Proven clinical criteria meet intelligent automation for payers
Many major health plans have pledged to simplify prior authorization, increasing the need for solutions that streamline reviews and minimize disruptions in the care journey. Building on 50 years of clinical leadership, InterQual Auth Accelerator pairs trusted InterQual Criteria with AI models trained and refined by clinical experts for timely medical necessity reviews. Responsible AI converts provider documentation into a machine-readable format for quick navigation and evaluation against criteria. Organizations can tailor automation from AI-guided reviews to fully automated approvals while maintaining human oversight. It does not auto-deny cases, keeping patient care decisions in expert hands.
Payers can advance their efforts to meet CMS 0057 requirements with InterQual Auth Accelerator to process urgent requests within 72 hours and standard requests within seven days. Early results show a 56% reduction in review time compared to typical workflows.
Together with Optum, a large New England health plan is advancing a shared commitment to innovation that strengthens outcomes and system efficiency. The collaboration is transforming prior authorization through InterQual expertise and AI, creating simpler workflows, and supporting timely, appropriate care.
Future of prior authorization
Optum is advancing the end-to-end prior authorization process to create a more connected and efficient health care experience. The new digital prior authorization solutions reflect the direction set by Optum Real, using the same AI capabilities behind real‑time authorization decisions to support a wider range of clinical and administrative needs.