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New MedCity Article: Insights on Why Automating Prior Authorization Requires Digitizing Medical Policy

Matt Cunningham, Strategic Innovation Partner at Availity, recently published an article in Medcity News titled “Digitizing Medical Policy Alone Will Not Automate Prior Authorization at Scale.” In this piece, he examines why digitizing medical policies alone is not enough to enable scalable prior authorization automation. Cunningham explains that without translating medical necessity criteria into executable clinical logic, health plans continue to face slow turnaround times, inconsistent decisions, and provider frustration, even with FHIR APIs and digital policies in place.

The article outlines:

  • Why digitized medical policies must move beyond static documents to clinician-aligned, machine-executable decision trees
  • How structuring policies around clinical workflows improves consistency, transparency, and automation outcomes
  • The importance of governance, traceability, and version control to support defensible, scalable utilization management

Read the full article here.