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California Limits Health Plan Use of AI in Utilization Management
Sheppard Mullin 
[Guidance Overview] Nov. 8, 2024 "Increasingly, health plans are relying on AI to streamline internal operations, including to automate review of prior authorization requests.... [The Physicians Make Decisions Act] provides that a determination of medical necessity must be made only by a licensed physician or a licensed health care professional who is competent to evaluate the specific clinical issues involved in the health care services requested by the provider. In other words, the buck stops with the provider, and AI cannot replace the provider's role." MORE >> |
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