Driving Faster Prior Authorizations in Healthcare with NLP and AI Technology

Pushback around prior authorization trends continues to make headlines, from a federal push to shorten prior authorization response times to a controversial attempt to require authorizations for gastroenterology procedures, a policy that has since been altered. But amid calls for meaningful change, there’s a way health systems can ease this process now, and it involves using Natural Language Processing (NLP) and Artificial Intelligence (AI) to ensure payers receive patient data in a structured format to speed decision-making processes.

One of the biggest challenges health systems face when it comes to prior authorizations is that the data doesn’t arrive in a form that health plans can immediately act upon. While most of these requests are sent electronically, typically, they take the form of an unstructured PDF. This makes it difficult for payer systems to ingest the data, requiring at least some manual data entry on the payer side before it can be sent for review. And even when a request is marked “urgent,” the request might not make it into the appropriate queue for urgent response.

Combine this with data errors resulting from manual entry and the struggle to keep up with health plans’ varying rules and forms for prior auth, and it’s a recipe for delayed care. More and more, prior authorization is required not just for specialty procedures like chemotherapy, but also for basic imaging and medication refills. These scenarios not only result in frustration for patients and providers, but also put lives at risk, such as when a cancer patient must wait for an approval before another session of chemotherapy can be delivered.

There is a better way—and it’s accessible to providers now.

The Power of NLP and AI to Speed Prior Authorizations

These inefficiencies have real consequences. According to the American Medical Association (AMA), 94% of physicians report that prior authorization delays negatively impact patient care outcomes, and 79% say patients have abandoned recommended treatments as a direct result of authorization burdens. One in four physicians has reported a serious adverse event linked to prior authorization delays.

Under the 2026 CMS rule, payers must now meet strict turnaround requirements—but those timelines are only achievable if the data they receive is structured, accurate, and immediately actionable. Health systems that continue to submit unstructured prior authorization requests will find themselves creating bottlenecks at the payer level, ultimately delaying the care their patients need.

NLP and AI technology, when combined with a powerful integration engine, can be a health system’s best bet for streamlining the prior authorization process.

NLP and AI work together by transforming unstructured PDFs—even handwritten documents—into the format health plans want to receive, which varies by payer. This facilitates faster decision-making, speeding referrals to specialists and access to treatment. It also protects continuity of care and improves patient outcomes, when the patient is able to receive the right care at the right time.

Our eFax^® Clarity solution leverages the most advanced NLP and AI capabilities available to extract clinical information and patient demographic data, like the patient’s name, birthdate and member ID number, from the PDF and apply it to the right fields in a digital form. This ensures the data can be easily consumed by the health plan’s IT system. And, unlike other commercial offerings, eFax^® Clarity leverages machine learning to recognize data fields and increase confidence scores, which in turn, leads to faster prior authorization decisions.

As mentioned previously, many authorization requests are sent to payers in unstructured data formats including pdf images from cloud faxes. Our solution, eFax^®, the most widely used platform for transmitting ePHI by fax for more than 30 years, can be combined with eFax^® Clarity and our powerful integration engine eFax^® Conductor, to take data exchange capabilities one step further. This level of innovation allows health systems to send a message using one type of protocol and convert the message to a more advanced structured standard without doing any heavy lifting. This means a digital fax can be converted to an HL7, FHIR or X12 message. Intelligent document processing (IDP) can provide vital data leading to actionable insights that streamline prior authorizations, so that patients can get the treatment they need sooner, and avoid any potentially serious health events. It’s Time for a Smarter Approach.

Health systems that continue to rely on manual prior authorization workflows face compounding risk: increased denial rates, administrative cost escalation, care delays, and potential compliance exposure as regulatory scrutiny intensifies. Conversely, organizations that invest in NLP and AI-driven automation today are building the operational infrastructure to thrive in a more demanding regulatory environment—and to deliver better outcomes for the patients they serve.

As the industry advocates for broader reform—including expanded gold-carding programs, reduced administrative redundancy, and greater payer transparency—providers need not wait for systemic change to act. The technology to streamline prior authorization is available now.

eFax^® and eFax^® Clarity provide the foundation for a smarter, faster, and more compliant approach to prior authorization in 2026 and beyond.

Click here to find more information on eFax^®’s approach to NLP and AI for prior authorization.

Stacy Pur

MBA, BSN, RN, SVP of Product