Use Case Work Groups
Description
The criteria matching component of an AI-supported prior authorization (PA) system automates the process of assessing whether a healthcare service, procedure, or medication meets the payer’s medical necessity guidelines.
Timeline
Q2 2025 - Q4 2025
Goals
Develop Responsible AI content that focuses on:
Critical best practice guidance and associated tools & resources
Methods, metrics, benchmarks, and open-source tooling to objectively evaluate responsible use of an AI-supported prior authorization criteria matching solution
Output
Best Practice Guidance:
link to guidance documentation once availableTesting & Evaluation Framework:
link to GitHub once available.
Work Group Leads
Name | Organization |
|---|---|
Samta Shukla | BCBS Minnesota |
Justin Brock | CVS Health |
Chris Burnett | CVS Health |
Christine Palermo | Encore Health |
Jeremy Friese | Humata Health |
Jan Sbarbaro | Lyric.ai |
Akshay Sharma | Lyric.ai |
Larry McEntire | MCG Health |
Travis Bias | Solventum |
Ajay Perumbeti | Solventum |
Abby Steele | UnitedHealth Group |
Tracee Coleman | UnitedHealth Group |
David Rivkin | UnitedHealth Group |
Fawad Butt | Penguin Ai |
Work Group Members
Airia
BCBS Minnesota
Children's Hospital of Philadelphia
CVS Health
Duke
Encore Health
Honor Health
Humata Health
Hyro
Innovaccer
Intervoice
Johns Hopkins Health Plans
http://Lyric.ai
Mayo Clinic
MCG Health
Mercy
MHK
New York Presbyterian
Penguin Ai
Providence
Reggie Health
Solventum
Stanford
Steer Health
Surescripts
UnitedHealth Group
WellSky
