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Abridge and Availity are partnering to develop a real-time prior authorization experience integrating utilization management directly into the clinician/patient conversation to streamline interactions between providers and health plans.
The initiative combines Abridge's enterprise-grade conversational AI platform with Availity's FHIR-native Intelligent Utilization Management technology to support medical necessity review and prior authorization workflows during clinical encounters, rather than after a visit has concluded.
The approach is designed to reduce administrative delays by aligning clinical documentation with payer requirements in real time.
Abridge provides AI technology that captures and structures clinical conversations, generating documentation aligned with clinical and administrative needs. The platform is currently used by more than 200 health systems.
Availity operates a health information network connecting payers and providers, offering tools that digitize coverage requirements and support administrative workflows across the healthcare ecosystem.
The collaboration relies on Availity's FHIR-native APIs to enable secure, scalable exchange of payer data, including coverage rules and utilization management requirements.
Abridge's Contextual Reasoning Engine is used to surface relevant clinical information during the encounter, allowing clinicians to address documentation needs as part of the conversation, rather than through separate, post-visit processes.
The companies are working to align workflows across their platforms in several areas, including utilization management, documentation and authorization review.
One focus area is simplifying prior authorization by aligning order submission and utilization management processes with the clinical encounter, with the goal of enabling payer determinations during the visit.
Another area centers on documentation gap visibility, where missing or incomplete information is identified while the clinician is still with the patient, rather than during downstream review.
By supporting prior authorization documentation and submission during the visit, the approach is intended to reduce manual workflows, administrative delays and resource-intensive processes such as peer-to-peer consultations.
THE LARGER TREND
The collaboration reflects a broader trend in health IT toward embedding administrative and revenue cycle functions into clinical workflows, using real-time data exchange and AI-driven context to support compliance and operational efficiency.
Real-time prior authorization is just one component of a broader effort to apply conversational intelligence across the revenue cycle.
Seattle Children's Hospital already implements Abridge's AI platform enterprise-wide to convert medical conversations into billable pediatric documentation, and Connecticut's Hartford HealthCare expanded use of Abridge's platform in September of last year after a successful pilot program.
Other companies in the AI medical documentation space include Commure, which in June 2025 raised $200 million in growth funding from General Catalyst's Customer Value Fund.
Microsoft's Nuance also offers a clinical documentation tool, Dragon Ambient eXperience (DAX) Copilot, formerly DAX Express, which uses OpenAI's model GPT-4.
