Agentic Administrative Automation for Prior Authorization and Revenue Cycle Integrity in Healthcare

Abstract

In 2026, the most deployment-ready healthcare AI use case is administrative: agentic systems for prior authorization and denial management. This is especially important for Asian LMIC health systems, where administrative delay compounds specialist scarcity and financing pressure. Properly scoped agents can automate chart abstraction, payer submission, status follow-up, and appeal drafting, improving turnaround and reducing avoidable denials. We argue that scale depends on bounded autonomy, auditable action logs, human override for high-risk steps, and payer-facing interoperability. We propose a practical implementation blueprint with risk-tiered controls, failure-mode monitoring, and value tracking through first-pass approval, appeal yield, delay reduction, and net administrative value. Agentic automation should be treated as accountable infrastructure rather than autonomous replacement of human judgment.

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