From Prior Authorization Chaos to Clear AI Orchestration

Prior authorization isn’t just broken — it’s unsynchronized. On this episode, Evan Martin, VP of Revenue Cycle Management at ZoomCare Inc as well as Host and Producer of The Wilshire’s IT RevCast, shares what happens when real-time care delivery meets a fragmented, rule-heavy prior auth system that can’t keep up. With just one authorization specialist covering 50 clinics, Evan paints a clear picture: today’s healthcare moves fast, but prior auth is still stumbling through a maze of plan-specific rules, outdated workflows, and underperforming automation tools. We explore how even routine imaging, meds, and mental health services become tangled in conflicting payer policies and benefit silos. Evan breaks down the bottlenecks, the firefighting, and the policy blind spots — plus why simply layering automation on top won’t fix it. The real opportunity? An orchestrated model powered by agentic AI triages, retrieves, and routes the right information to the right place — so human teams can actually focus on patient care. This isn’t theory. It’s the lived complexity of treating patients while waiting for permission — and what the future could look like if we finally got the process in tune.

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Revenue Cycle Optimized: From Prior Authorization Chaos to Clear AI Orchestration

RADIO FOR THE HEALTHCARE INDUSTRY
Healthcare NOW Radio and Podcast Network offers discussions on the latest developments and trends impacting the industry including: health tech, health IT, healthcare innovation, healthcare policy, healthcare data security, telehealth, interoperability, biotech, med tech, value-based care, pharma, healthcare compliance, and much more. Shows are hosted by industry thought leaders. Guests are a "who's who" across the healthcare spectrum.  The listening audience is predominantly physician and hospital-based, and the healthcare industry at large.

Revenue Cycle Optimized: From Prior Authorization Chaos to Clear AI Orchestration

Healthcare NOW Radio Podcast Network