AI Learning Collaborative
Use Case 1: Responsible AI in Prior Authorization for Health Plans
Artificial Intelligence (AI) is rapidly reshaping health care. From supporting timely, consistent, and accurate utilization management decisions, to improving data quality and accelerating quality measurement, AI is already influencing how care is delivered and managed.
NCQA’s AI Learning Collaborative will help organizations adopt and evaluate AI-enabled workflows with quality, safety, equity, transparency, and accountability. The Collaborative will run in cycles focused on specific high impact use cases. The first use case for which we are opening applications is AI-enabled prior authorization. This will be an eight-month learning program. Additional information about the learning collaborative can be found here.
This learning collaborative is run by the National Committee for Quality Assurance (NCQA) in partnership with Duke Institute of Health Care Innovation (DIHI).
Benefits of Program Participation
- Shape development of and gain access to a living industry-leading practices playbook outlining practical approaches to apply AI in prior authorization workflows, including a framework for monitoring outcomes.
- An NCQA and DIHI led anonymous quantitative and qualitative assessment of your organization’s AI implementation for prior authorization. The assessment will compare your workflows with the emerging playbook and provide de-identified, aggregate benchmarking against participating peer organizations, as permitted under the participation agreement.*
- Regular opportunities to learn from your peers and gain insight into implementation challenges and solutions.
*Please note: information collected as part of the Learning Collaborative will be de-identified, used in aggregate, and treated as confidential, in accordance with participation agreements.
Cost
This learning collaborative is a paid opportunity, costing $25,000 per organization. Community-based plans or health plans with fewer than 500,000 members may be eligible for a discounted fee. If your organization meets these requirements and is interested but unable to pay the full fee, please reach out to ai@ncqa.org.
Eligibility
Health plans at any stage of AI maturity, from exploratory efforts interested in adopting a prior authorization AI solution, to pilot or scaling, are eligible to apply for this collaborative. Figure 1 broadly outlines 6 stages of prior authorization identified as the focus of this cohort. Selection will balance multiple organizational characteristics including stages of maturity, organizational size, populations served and lines of business.
Accepted organizations are expected to:
- Attend regular Collaborative meetings: including orientation, kick off, discussion-based meetings, office hours and 1:1 conversations.
- Share information: share outcomes metrics, participate in surveys and interviews about workflow and processes
- Be an Active Participant: openness about challenges, opportunities, and lessons learned from your AI journey are critical for participating in this collaborative. All members must be willing to share their experience and actively listen to others, fostering a culture of peer learning.
- Commit the Appropriate Resources: organizations should commit a small, cross-functional team to support this work, with an estimated total commitment of 8–10 hours per month across the team, not per individual team member.
Applicant and Participant Expectations
Applicants selected for participation will be expected to:
- Submit a complete application by 8/11/2026.
- Identify and commit resources to support participation.
- Garner the necessary internal buy in to sign a contract within two months of acceptance and remit payment within 30 days of contract signature.
For questions about the Collaborative or application process, please contact ai@ncqa.org
APPLICATION STARTS HERE:
Before you begin
The questions below are intended to assess program fit, support development of a balanced cohort, understand each organization’s starting point, tailor Collaborative discussions, and establish an initial baseline for participating organizations.
This application asks for information about AI implementation and operational capabilities. Application responses will be treated as confidential and reviewed only by NCQA and Duke Institute of Health Care Innovation (DIHI) for participant selection and related planning. Responses will not be shared outside the selection process.
To reduce burden and protect sensitive operational details, this public application focuses on initial fit and readiness information. NCQA and DIHI may request more detailed metrics-availability information through a confidential follow-up after initial application review, selection, or contracting.
Please answer the questions below to the best of your ability. If a question is not applicable or information is not yet available, note that in your response.