In recent years, payers have come under intense scrutiny as they increasingly adopt AI tools to automate tasks such as claims review and prior authorization requests. Providers have expressed concerns about the impact this could have on patients’ access to timely care, with American Medical Association survey last year showing that 61% of doctors are concerned that payers’ use of AI will increase prior authorization denials.
During an interview this week at LIVE conference in Los Angeles, Ratnakar Lavu, Élevance Santé‘s chief digital information officer said his company had drawn a clear line against using AI to deny claims. Although Elevance uses AI to expedite prior authorization approvals and streamline claims processing, denials still remain subject to human review.
Lavu explained that Elevance has adopted AI tools to analyze claims for missing information to prevent claims from getting stuck in the system.
“If there is some type of additional testing that needs to take place, we will send it to a clinician,” he said.
He noted that Elevance has also invested in AI to power virtual assistants, which can help members find affordable providers, answer questions about procedure coverage and provide cost breakdowns.
Elevance has also integrated AI into its call centers, using it to synthesize information from multiple systems so agents can quickly resolve members’ questions. Lavu highlighted that AI models also generate large-scale post-call recaps to identify opportunities for improvement across approximately one million interactions per month.
According to him, this all depends on a commitment to responsible AI. Lavu said Elevance has implemented a governance program aligned with the NIST AI Risk Management Frameworkwhich focuses on explainability, transparency, bias mitigation, hallucination prevention, and human auditing of AI results.
The company also collaborates extensively. Lavu said Elevance works with large companies like Anthropic, OpenAI, Google and AWS, as well as healthcare AI startups, to help them “think about the complexity of healthcare.”
The payer works with these companies to help them understand the reality of healthcare workflows, as well as the policy and reimbursement dynamics that influence how the tools are used in practice.
Lavu framed these initiatives as part of Elevance’s broader strategy to balance innovation with security and trust. Questions remain about the real impact of AI on clinical workflows and patient experience, but Lavu believes that careful deployment and continuous evaluation are key to moving the needle.
Photo: jetcityimage, Getty Images
