Google Cloud And Inovalon Ink Deal To Build Prior Authorization Agentic AI System

The prior authorization process is one of the most time-consuming aspects of the clinical workflow.

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Healthcare data and analytics pioneer Inovalon announced that it will be partnering with Google Cloud to aid one of the most cumbersome aspects of care delivery: prior authorizations.

The prior authorization process refers to seeking approval by an insurance company or payer for a specific procedure, therapeutic or medical service. Notoriously, the process is not as simple as submitting a request online; rather, it is an incredibly time consuming aspect that takes up a significant portion of staff resources, as physician offices have to check insurance requirements, understand each patient’s specific coverage metrics, and submit specific paperwork to the insurance company, often without much guidance or proactive instructions. The insurance company may then delay or deny the request, which kicks back the paperwork to the doctor’s office and starts the entire process all over again. Undoubtedly, this is one of the biggest pain points in the healthcare delivery value chain in America.

Fortunately, with recent advancements in generative AI, there is significant opportunity to streamline these processes and use agentic systems to introduce automation.

This is exactly where Inovalon is leveraging Google Cloud’s platform to innovate in conjunction with its own incredibly vast datasets. Together, the goal will be to develop an agentic system that will be physician facing and will use AI to comb through existing data sets to ease the paperwork process. Specifically, the workflow will entail the physician or provider engaging directly with the agent, which will assess what kind of insurance benefits a patient has and compare the allowances with the ordered tests and services requested. The agent will then parse through historical EMR data, understand the holistic patient journey and history, and automatically generate the necessary prior authorization paperwork, ready to be submitted.

This will have significant impact on the healthcare landscape, as administrative burdens have never been higher. Numerous studies indicate that physicians have increasingly become overburdened with non-clinical tasks that routinely pull them away from direct patient care; in fact, many hospital systems are facing record attrition due to these factors. Furthermore, each minute and hour spent away from direct patient care adds to rapidly increasing wait-times and access-to-care inequities.

Aashima Gupta, Google Cloud’s global director of healthcare strategy & solutions, explains that the prior authorization process is an incredibly challenging piece to solve and is a huge source of administrative burden for clinicians; with Inovalon’s data and Google Cloud’s platform, there is significant opportunity in this space to make a positive difference for physician workflows.

Dr. Paige Kilian, Chief Medical Officer at Inovolan, further states that the technology is incredibly promising, and will still include a key facet: human judgement. The tool will ultimately entail heavy oversight by physicians and human staff in order to make it truly successful. This is something that has become a key aspect of agentic systems in healthcare: keeping humans in the loop to ensure a humanistic touch and advanced judgment in all outputs.

Indeed, the race for AI supremacy, especially in the world of healthcare, is just getting started. The release of GPT-5 by OpenAI underscored that a significant amount of search and AI foot traffic by consumers revolves around healthcare related topics. Furthermore, at an enterprise level, the competition is certainly stiff, as numerous AI players are quickly racing to provide healthcare systems with curated and tailored functions to serve their needs.

Undoubtedly, as the future of AI seems to be overwhelmingly moving towards the use of agentic systems to ease workflows and efficiency, the potential for value realization has never been higher.