Humata is Showing How AI-Driven Prior Authorization Can Transform the Medical Insurance Approvals Process at Scale


Our mission at Humata Health is to help patients get the care they deserve, as quickly as possible, without the delays and frustration that have long defined prior authorization. We are working with Optum, an organization that shares this vision, to make the process work better for everyone.

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Together, we are embedding real-time approvals and AI-driven automation into clinical workflows, reducing administrative burden and helping patients get timely care. Our shared goal is to create a faster, more efficient and transparent approval process with prior authorization that becomes virtually invisible to patients and providers.

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Working with this industry leader, which serves 129 million consumers and works with over 90,000 physicians, gives us the ability to simplify and streamline prior authorization in a way that meaningfully reduces friction across the system. This approach will provide value on both sides of the healthcare coin for providers and payers, while creating a smoother experience for the people who rely on timely care.

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Optum Digital Auth Complete, powered by Humata integrates intelligent authorization capabilities directly into the EHR. Humata’s platform will assemble clinical documentation, align submissions to payer-specific rules and submit requests. By turning prior authorization into an automated process, we’re giving providers and their staff back the time they need to focus on their most important priority: caring for people.

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A Mission-Driven Approach

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At Humata we like to say we're “Built for Yes” because we help providers submit better prior authorizations to get to “yes” faster. Our results so far speak for themselves. Our partners have seen a 45% reduction in manual touches and an 80% increase in processing efficiency. We’ve achieved a 96% first-pass approval rate in recent partnerships, meaning most requests are approved immediately, and on the first attempt.

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The Need for Innovation

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On the provider side, the significant administrative burden of prior authorization is well-documented. Providers and their staff spend 13 hours a week on related tasks, with 40% of physicians employing staff that work exclusively on prior authorizations. I experienced the frustration of this process firsthand during my nearly 20 years as an interventional radiologist at Mayo Clinic.

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Each day my nurse would hand me a stack of manila folders. Instead of patient charts for the day’s procedures, they were prior authorization requests that needed approval before we could even schedule the surgeries my patients needed.  I saw that to solve the prior authorization problem, manila folders had to be replaced by intelligent automation that would free up physicians to spend more time on treating patients and less on paperwork. It also had to help payers, who need the ability to make evidence-based decisions quickly, without layers of administrative burden. All of these improvements ultimately benefit patients. That’s why Humata was founded.

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A Shared Path Forward

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Healthcare transformation is a marathon, not a sprint. Working with Optum will allow us to take on a challenge that felt intractable for years and solve it at real scale. Together, we are moving past incremental improvements to fundamentally improve the way prior authorization works in real time, for real people. By combining deep clinical leadership with Humata's advanced AI technology, we will create a seamless experience that showcases what is possible for the prior authorization ecosystem. At the end of the day, we are working to ensure the system works better for everyone.

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