Healthcare / Health system
Summit Health: Preparing and submitting medication prior authorization requests
- Company
- Summit Health
- Country
- United States
- Adoption stage
- In operation
- Source published
- Date basis
- The date the source was published. It can differ from the date adoption started.
- How the source was checked
- Read the full source text
The work problem
Epic's material said prior authorization had historically been a time consuming process for both patients and clinicians. To prescribe a drug, staff must fill in the paperwork a payer asks for, send it, and wait for a reply. The work breaks the flow of care and leaves clinicians with administrative load. Epic said it built a setup in which Art, its AI for clinicians, works together with Penny, its AI for revenue cycle and operations, to cut through that complexity.
Technology and data
Art covers the clinician side of the work and Penny covers the revenue cycle and operations side. The two move together to gather what a prior authorization needs and to draft the responses that go on the submission. Staff review that draft and either send it as it stands or edit it first. Summit Health applied this setup to medication prior authorization submissions. Epic said Penny will go on to complete coding sessions and appeal submissions on its own, inside the guardrails each organization sets.
Results
Epic said that at Summit Health, Penny cut medication prior authorization submission time by 42%. It said 92% of the AI generated responses are accepted without edits. At the organizations using Penny most actively, coding related denials fell by more than 20% and denial appeal letters were created 23% faster. Epic summarized the effect as patients getting answers faster and clinicians facing less administrative friction.
Limits and open questions
The source does not say when Summit Health turned the feature on, how far the covered drugs and payers reach, or how many submissions were handled. The 42% and 92% figures are the ones Epic presented. The drop of more than 20% in coding denials and the 23% faster appeal letters are pooled across the organizations using Penny most actively, so they cannot be read as results for Summit Health alone.
Sources
Compiled from public sources. These are not results from ATF Works customers.