Artificial Intelligence for Utilization Management

Payers can see the predicted service-level agreement (SLA) breach scores for prior authorization review requests and the top factors that possibly contribute to SLA breaches on the Prior-Authorization Review SLA Breach Prediction dashboard. They can see services that they are likely to receive from providers and previously submitted services authorization requests for a member on the Recommended Services Pathway dashboard. Providers can see services that they are likely to request on the Recommended Services Bundling dashboard.