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Trust by Design: Human-in-the-Loop AI and the Future of Utilization Management
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About this webinar
Prior authorization is undergoing a fundamental shift from manual, fragmented workflows to electronic, AI-enabled, and increasingly regulated processes. As health plans prepare for evolving CMS requirements and tighter response timelines, the challenge is no longer simply how to automate prior authorization, but how to automate it responsibly.This session will explore how health plans can modernize utilization management through electronic prior authorization and human-in-the-loop AI, balancing speed and efficiency with clinical judgment, transparency, compliance, and trust. Experts from Innovaccer and Mastek will discuss what plans need to do now to build a future-ready UM operating model for 2027 and beyond.
What you'll learn
- The Shift to Electronic Prior Authorization: How health plans are adopting ePA and preparing for faster response timelines and more connected provider workflows.
- CMS 0057 Readiness: Are health plans equipped with the technology, data, APIs, and operational capabilities needed to meet evolving CMS prior authorization requirements?
- AI + Human Judgment in UM: Where should AI automate decisions, where must clinicians remain in control, and how can plans build trustworthy human-in-the-loop workflows?
- Designing Trust and Transparency Into Prior Authorization: How explainable decisions, clinical rationale, status visibility, and auditability can improve provider and member experience while strengthening compliance.
- Building the Future-Ready UM Operating Model: What health plans should prioritize today to create a scalable, compliant, and AI-enabled utilization management operation for 2027 and beyond.
Who you'll hear from
Amanda Jara
Innovaccer
Sr. Director - Clinical Operations·
Subha Bhattacharya
Mastek
Vice President - Healthcare
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