National Survey of U.S. Providers Shows Trust in AI to Improve Prior Authorization as Looming Standards Raise the Stakes

Survey from Cohere Health finds overwhelming support for AI and digital-first solutions to ease administrative burden and speed patient access to care  

BOSTON, Oct. 7, 2025 /PRNewswire/ -- Cohere Health^®, the leader in clinical intelligence for health plans and risk-bearing providers, today released findings from its 2025 National Provider Survey on Prior Authorization. The research, which included 200 U.S. clinicians and office administrators, found nearly universal trust in using artificial intelligence (AI) for prior authorization (PA) approvals, with 99% of clinicians and 96% of office administrators reporting confidence in AI-driven PA. This broad endorsement signals the growing demand for digital innovation to reduce provider burden, improve patient care access, and transform PA.

The survey also highlights what's at stake if legacy systems remain unchanged:

• 97% of administrators and 93% of clinicians have seen PA delays cause avoidable emergency care or hospitalizations.
• 55% have witnessed patients abandon treatment because of PA delays.
• 95% of administrators and 92% of clinicians said the PA process is a burden, with one in ten clinicians linking it to burnout.

"Providers are speaking loud and clear: they want and deserve a prior authorization process that is smarter, simpler, and more transparent," said Dr. Brian Covino, chief medical officer of Cohere Health. "Our responsible, clinically trained and patient-centric AI doesn't replace clinical judgment–it strengthens it. By helping health plans and providers better collaborate on timely, consistent, and appropriate decisions, we reduce administrative burden, safeguard patient care, and promote equity across the system."

Modernization emerged as a clear priority in the survey results. Two-thirds of respondents said a fully digital PA experience would significantly improve their workflows, and nearly all agreed the process should include real-time tracking, providing visibility into where a care request stands at any point. Combined with overwhelming trust in AI, these findings highlight a strong opportunity for health plans to streamline PA with clinical-grade AI, making the process more efficient and responsive to providers' needs.

The survey also found that outdated processes continue to disrupt care delivery. Only 16% of office administrators and 24% of clinicians use electronic PA platforms for more than 40% of submissions, and about a quarter of requests are still submitted via fax or phone. Many providers also remain unclear about health plan requirements; 92% of clinicians and 89% of administrators said they are frequently unsure if a treatment even requires authorization.

With new federal requirements taking effect on January 1, 2026, health plans must move quickly to modernize PA and meet compliance. The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) will require health plans to respond to PA requests within 72 hours for urgent requests and seven days for standard requests. Today, only 12% of clinicians and 7% of administrators consistently receive decisions within those timeframes. These rules, combined with federal and industry commitments from CMS, HHS, and AHIP, underscore the urgent need for health plans to adopt streamlined, AI-enabled PA solutions.

Cohere Health is committed to transforming prior authorization, helping health plans modernize their utilization management workflows, protect patients from unnecessary risk, and give clinicians more time to focus on care. By integrating responsible, precision AI with clinical expertise and advanced digital innovation, Cohere Health is making PA faster, smarter, and more transparent for all involved.

The full findings are detailed in Cohere Health's new white paper, The Hidden Cost of Prior Authorization, available now at http://www.coherehealth.com/thought-leadership/the-hidden-cost-of-prior-authorization.

About Cohere Health ^®  
Cohere Health's clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. Cohere Health works with over 660,000 providers and handles over 12 million prior authorization requests annually. Its AI auto-approves up to 90% of requests for millions of health plan members. The company has been recognized on the 2025 Inc. 5000 list and in the Gartner^® Hype Cycle™ for U.S. Healthcare Payers (2022-2025), and is a Top 5 LinkedIn™ Startup for 2023 & 2024.

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SOURCE Cohere Health