Abridge, an enterprise AI platform for clinical conversations, and Availity, a real-time health information network, have partnered to introduce a new prior authorization experience. This collaboration leverages technology rooted in clinician-patient conversations to improve efficiency in the medical necessity review process between clinicians and health plans.
The initiative aims to integrate shared clinical context directly from patient conversations into administrative workflows, such as prior authorization review and submission. This approach is designed to enhance patient outcomes and support care teams. The partnership combines Abridge’s AI platform, which serves over 200 health systems and is projected to support more than 80 million patient-clinician conversations by 2026, with Availity’s FHIR-native Intelligent Utilization Management solution. Availity’s solution assists payers and providers in digitizing coverage requirements within administrative processes, utilizing FHIR-native APIs for secure and scalable connectivity across the healthcare ecosystem.
Abridge’s Contextual Reasoning Engine technology is intended to provide clinicians with relevant clinical information during patient conversations, supporting documentation that aligns with prior authorization requirements. Russ Thomas, CEO of Availity, stated that the company has invested in AI-powered, FHIR-native APIs to embed clinical policy logic directly into provider workflows. He added that integrating their technology at the point of conversation facilitates faster, more transparent utilization management decisions based on clinical context, expressing enthusiasm for the collaboration with Abridge.
This real-time prior authorization development is part of a broader revenue cycle collaboration focused on applying real-time conversational intelligence across patient, provider, and payer interactions. The companies plan to integrate their platforms in several key areas:
Simplified Prior Authorization: This involves aligning utilization management and order submission within the clinical conversation, with the goal of enabling payer determination during the patient visit.
Documentation Gap Visibility: The collaboration aims to highlight documentation deficiencies during the conversation, rather than after, to support high-quality, compliant, and clinically accurate documentation reflective of the patient’s current condition.
Authorization Integrity: By supporting more complete and accurate documentation at the point of conversation, the objective is to reduce downstream administrative cycles between payers and providers, keeping patient needs central to the request.
Reduced Administrative Burden: The initiative seeks to assist clinicians with prior authorization documentation and submission during visits, aiming to help both payers and providers reduce manual workflows, administrative delays, and resource-intensive needs such as peer-to-peer consultations.
Dr. Shiv Rao, CEO and Co-Founder of Abridge, commented on the partnership, noting that both Abridge and Availity bring national scale, trust, and experience in addressing challenges across care and claims. He described the effort as building real-time bridges between patients, providers, and payers, fostering shared understanding at the point of conversation. Abridge, founded in 2018, transforms medical conversations into clinically useful and billable documentation at the point of care, having received accolades such as Best in KLAS 2025 for Ambient AI. Availity, described as the nation’s largest real-time health information network, connects to over 95% of payers, more than 3 million providers, and over 2,000 trading partners, facilitating the exchange of clinical, administrative, and financial information.
