Shape the Future of AI in Prior Authorization: Apply to Join NCQA’s Learning Collaborative

Artificial Intelligence (AI) is rapidly reshaping health plan operations. While some organizations are actively piloting or scaling AI solutions, others are still determining where to begin. Regardless of where your organization sits on the AI adoption curve, scaling AI responsibly, transparently and effectively is foundational.

Across the industry, initial efforts have focused on defining governance principles and foundational controls for responsible AI use. The next challenge is translating those principles into complex workflows while measuring the impact on quality, outcomes and experience.

To support healthcare organizations in navigating this transformation, NCQA is launching an AI Learning Collaborative, with our first use case focused on prior authorization. Building on conversations from NCQA’s prior AI convenings, the Learning Collaborative provides a structured, in-depth engagement model designed to support implementation and evaluate outcomes at the workflow level.

Responsible Use of AI in Prior Authorization

Prior authorization represents a high-risk area for AI adoption given its complexity, visibility and direct patient impact. While AI offers meaningful opportunities to improve efficiency and turnaround time, it also raises important questions about transparency, process integration and measurable outcomes.

This Learning Collaborative is timely, as organizations prepare to implement the CMS Interoperability and Prior Authorization Final Rule (CMS-0057), which focuses on reducing friction for clinicians and patients, improving information exchange and demonstrating explainable, timely decisions.

How the Learning Collaborative Works

The Learning Collaborative is a fee-based experience designed to help you learn from peers, engage with national experts and develop best practices for responsible AI implementation and impact evaluation. Participants will:

• Engage in peer learning on real-world AI implementation.
• Strengthen governance, accountability and outcomes measurement frameworks for specific use cases.
• Share anonymized outcomes metrics and evaluate implementation effectiveness and variances against peers.
• Contribute to and access evolving, use-case-specific implementation playbooks and outcomes-monitoring frameworks.

Benefits of Participating in the AI Learning Collaborative

NCQA’s AI Learning Collaborative is designed to support organizations across the maturity spectrum, offering both foundational guidance and opportunities to validate and optimize existing strategies. Participating organizations can:

• Shape emerging industry best practices.
• Accelerate AI innovation responsibly.
• Develop new metrics and evaluation methods within workflows.
• Align with regulatory expectations, including CMS-0057 and state-specific requirements.
• Build public trust by promoting transparency and accountability.

Join Us!

Visit our website to learn more about the AI Learning Collaborative and find out how your organization can participate.