AI agents are being deployed to streamline the prior authorization process in healthcare by automating document retrieval, request submissions, and status monitoring. These systems are designed to integrate with provider workflows, with new API requirements under the CMS Interoperability and Prior Authorization Final Rule set to take effect by January 1, 2027.
Beyond administrative tasks, AI agents are evolving into care navigators that manage patient discharge plans, schedule specialist visits, and coordinate transportation. CVS Health has begun implementing this approach through its Health100 platform, developed in collaboration with Google Cloud to provide real-time support across pharmacies and insurance providers.
The technology is also being applied to clinical trial matching. A 2026 study in Nature Communications on the TrialMatchAI system demonstrated that the tool could identify relevant trials for 92% of oncology patients within its top 20 recommendations, with experts confirming over 90% accuracy in eligibility assessments.
While these agents handle data processing and administrative coordination, human clinicians retain authority over medical judgments, final screening, and enrollment processes. The primary objective of these tools is to reduce administrative delays and ensure that care plans remain active without requiring constant manual intervention from medical staff.
