Charlotte, N.C.-based Advocate Health is transforming how its pharmacies handle prior authorizations. The health system now uses AI within Epic to replace outdated, phone and fax-based processes. According to a May 4 Epic case study, the results are striking. Staff complete authorizations faster, submit requests sooner, and spend far less time on administrative tasks. This shift signals a broader movement toward AI-powered efficiency in healthcare revenue cycle operations.
From Fax to Digital: Replacing Legacy Workflows
For years, prior authorization for specialty medications depended on phone calls and fax machines. These methods consumed valuable staff time and introduced unnecessary delays. Advocate Health tackled this problem directly by switching to fully digital workflows inside Epic.
Why Legacy Systems Created Bottlenecks
Traditional fax-based processes required staff to manually compile documentation, wait on payer responses, and follow up repeatedly. Each step added time and friction. Consequently, patients sometimes waited longer than necessary for essential medications. Advocate Health recognized this gap early and moved decisively toward a digital-first approach that puts speed and accuracy at the center of the workflow.
AI-Generated Responses Speed Up Payer Questionnaires
One of the most impactful changes at Advocate Health involves AI-generated draft responses. When payers request questionnaires tied to prescription prior authorizations, the system now generates draft answers automatically. Staff then review and submit these drafts rather than composing responses from scratch.
How AI Drafts Reduce Manual Effort
The AI pulls relevant clinical information directly from existing patient records. Next, it drafts responses aligned with payer requirements. As a result, staff spend less time searching through charts and more time on direct patient care. This shift marks a significant improvement in both pharmacy workflow efficiency and overall staff satisfaction.
Time Savings Transform Pharmacy Staff Workflows
Perhaps the most remarkable outcome is the dramatic reduction in time spent per authorization. Previously, pharmacy staff devoted as many as 25 minutes to each prior authorization request. Today, the AI-assisted workflow brings that figure down to approximately five minutes.
What a 20-Minute Reduction Means in Practice
Consider a pharmacy handling dozens of authorizations daily. A 20-minute saving per case adds up to hours of recovered staff time every single day. Furthermore, that freed-up time lets pharmacists focus on clinical responsibilities rather than paperwork. The efficiency gain benefits both staff and patients in measurable, immediate ways.
Faster Submissions: One Full Day Gained
Beyond per-case time savings, Advocate Health also accelerated the overall submission timeline for prior authorization questionnaires. The health system cut response time by a day or more. Requests now reach payers an average of one full day sooner than before.
Earlier Submissions Mean Faster Patient Access
When requests arrive at payers earlier, approvals return sooner. Consequently, patients gain access to specialty medications faster. This improvement directly supports patient outcomes by reducing treatment delays that stem from administrative slowdowns — a chronic pain point across health systems nationwide.
System-Wide Expansion Across Pharmacy Operations
Initially, Advocate Health piloted the AI tools in select areas. Following that early success, the health system expanded the automation across specialty, outpatient, and centralized retail pharmacy operations. Importantly, staff played an active role in shaping this expansion. Their feedback guided improvements to both the automation tools and the AI-drafted response features.
Staff Involvement Drives Sustainable Adoption
Technology adoption succeeds when frontline workers help shape it. Advocate Health understood this principle well. By involving pharmacy staff in the feedback process, the health system built genuine trust in the new tools. Moreover, staff-driven improvements made the system more practical and better suited to real-world workflows — reducing resistance and accelerating adoption across departments.
Why AI-Driven Prior Authorization Matters Now
Prior authorization remains one of healthcare’s most persistent administrative burdens. Physicians, pharmacists, and patients frequently cite approval delays as a major pain point in care delivery. AI tools embedded within EHR platforms like Epic now offer a practical, proven solution to this long-standing problem.
Advocate Health’s experience demonstrates that AI prior authorization is not a distant aspiration. It is a working reality delivering measurable results today. Health systems that adopt similar approaches can reduce staff burnout, accelerate patient care, and lower administrative costs — all at once.
As more organizations examine their own authorization workflows, Advocate Health’s model offers a clear and replicable blueprint for digital transformation in healthcare.
