Salesforce (CRM) and Blue Shield of California have partnered to create an AI-driven system aimed at speeding up the approval process for patient care. The collaboration, which will be announced today, seeks to cut down the time it takes for insurers to approve treatments, potentially reducing weeks-long delays to same-day decisions.
The system, built on Salesforce’s healthcare cloud, is designed to help streamline prior authorizations—decisions insurers make to determine whether a treatment or service is medically necessary. While some insurers have faced criticism for using AI to deny claims, Blue Shield promises that a human will always remain part of the decision-making process.
“We are not going to deny care without a human in the loop,” said Blue Shield CEO Paul Markovich. This approach, he added, will avoid the backlash seen by other insurers that rely heavily on AI.
The AI system will expedite approvals by checking if all the necessary steps, like imaging scans or alternative treatments, have been completed before greenlighting a procedure. Salesforce’s executive VP, Jeff Amann, highlighted that this process can reduce the time from weeks to “near real-time.”
As this system rolls out through 2025, Blue Shield hopes to eliminate outdated technologies, like fax machines, that still slow down healthcare communications.