Highmark Health to Deploy Abridge AI Documentation and Develop Prior Authorization Solution

Highmark Health will implement Abridge’s ambient clinical documentation technology across its network, which includes 14 hospitals and hundreds of clinics. The organization also plans to collaborate with Abridge to codesign an AI-powered prior authorization tool at the point of care, along with other tools integrating highmark health will implement abridge’s technology.

Highmark Health operates Highmark Inc., a multistate insurance services division, and Allegheny Health Network (AHN), a 14-hospital care provider. Richard Clarke, Ph.D., Highmark Health’s chief analytics officer, said the prior authorization tool will initially be tested with Highmark Health members seeing AHN clinicians using highmark health will implement abridge’s technology. “We’re definitely designing this in a way that we expect it to scale, both in terms of other payers at Allegheny Health Network, but also other providers beyond that,” Clarke said.

Highmark evaluated several ambient clinical documentation providers before selecting Abridge. More than 500 clinicians tested multiple vendors across various specialties and subspecialties. Abridge’s AI technology generates structured clinical note drafts in real time from patient-clinician conversations and integrates them into the electronic health record. Highmark Health will implement Abridge’s platform to capture these conversations, with patient consent, via secure devices, minimizing extra steps for clinicians.

• How Highmark Health Will Implement Abridge’s Across Its Network

The rollout will start in AHN outpatient facilities, with expansion planned to emergency departments, hospitalist programs, and home care environments. According to the organization, use of ambient scribe technology has led to 92% of patients reporting that their providers appeared more attentive during visits. AHN clinicians involved in pilot testing reported significant improvements in documentation and workflow efficiency. This aligns with wider industry findings that ambient clinical intelligence can lessen documentation burden, speed note closure, and reduce after-hours workload. PMC+2Journal of AHIMA+2

Through the collaboration, Abridge is also expanding its AI capabilities to address administrative processes such as prior authorization. Its AI system can complete forms, submit and review requests, track their status, and determine when prior authorization is required. It provides a real-time checklist of criteria for specific procedures, with clinicians reviewing recommendations before submission. Highmark Health will implement Abridge’s system to bring prior authorization into the same visit rather than leaving it as a post-visit task. Becker’s Hospital Review+2Abridge+2

Shiv Rao, M.D., CEO of Abridge, said Highmark Health and AHN are among the few organizations that have significantly changed how prior authorization functions across their system. He added that the partnership will allow both sides to apply AI to these workflows to further enhance them.

The organizations said the goal is to reduce the burden of prior authorization on clinicians and administrators, enabling patients to receive timely care and reducing the process from weeks to minutes. Initial testing will focus on a specific procedure within a specialty before expanding to other areas.

Clarke stated that Highmark Health’s structure as both a payer and provider positions it to develop solutions that require collaboration and trust. The organizations said their approach moves prior authorization to the point of conversation, rather than after the patient encounter. They also noted this is the first of multiple joint development projects planned under their collaboration agreement.

---

Additional Content: Impact and Implications

Since the announcement that Highmark Health will implement Abridge’s ambient and prior authorization technologies, there has been strong interest from other health systems and payers. Experts suggest this move could become a model for reducing friction among providers, insurers, and patients. If successful, the approach could transform administrative workflows across US health care, cutting costs, decreasing delays in care, and improving provider satisfaction.

Some key implications include:

• Provider efficiency gains: Clinicians may spend less time on paperwork and more time in meaningful patient interaction.

• Faster care delivery: When prior authorization is handled in the course of the visit, patients can move forward with treatments or procedures without weeks of waiting.

• Cost savings: Reduced administrative overhead and fewer delays may lead to lower costs for both providers and insurers.

• Patient experience improvements: Less frustration for patients when insurance requirements are clear during the visit, and fewer surprises afterward.

Highmark Health will implement Abridge’s tools with careful oversight. Privacy, accuracy, and provider control over documentation remain top priorities. As tests expand into emergency departments and hospitalist programs, feedback from clinicians will guide refinements. Highmark’s dual role as insurer and care provider gives it a unique window into both policy and clinical operations, which may help overcome common hurdles in AI deployments.