Beyond the Rules Engine: How Agentic AI Is Helping Health Plans Solve Prior Authorization

Healthcare automation has long been sold as a cost-saving means of increasing efficiency, delivering better care, and reducing errors. But when faced with the ambiguous realities of the day-to-day clinical workflow, most of the proposed approaches have failed in the past. That’s because the majority of systems are still based on an explicit programming style: the if X, then Y rule-based logic. Organizations need a more flexible, contextualized, and autonomously intelligent approach to automation to truly modernize some of the most complex and abrasive manual processes that continue to plague the industry. Agentic AI delivers this blend. Even though agentic AI may feel new, it’s been around for many decades. It first emerged in the 1960s when computers were small, slow, and had limited capabilities. Early AI pioneers needed a way to break down large, complex problems into manageable pieces.