R1 Aims to Cure Healthcare's $35 Billion Prior Authorization Headache with New AI Platform

CHICAGO, IL – January 15, 2026 – Healthcare revenue management leader R1 today announced the launch of a new technology platform designed to automate one of the most frustrating and costly bottlenecks in American healthcare: the prior authorization process. The new solution, R1 Prior Authorization, leverages artificial intelligence and a vast repository of payer data to accelerate care approvals, a move the company claims can clear the majority of requests within an hour and dramatically reduce care delays for patients.

The announcement targets a well-known pain point for providers and patients alike. Prior authorizations—the requirement for providers to obtain advance approval from payers for a medical service or prescription—are a major source of administrative friction. Industry estimates place the annual cost of this process at a staggering $35 billion, and a recent study found it is responsible for causing 92% of care delays.

Built on its Phare Operating System, R1's new solution promises to replace the traditional, manual workflow of phone calls, faxes, and paperwork with a streamlined, intelligent system. The company reports that in early use, the platform has cleared 68% of all orders in one hour and nearly 97% within a single day, all while maintaining an average auth-related denial rate of less than 1%. For healthcare systems facing immense financial pressure, these metrics represent a significant opportunity for cost savings and operational efficiency.

Technology Meets Human Oversight

At the core of R1 Prior Authorization is a three-step process—determination, submission, and completion—managed by Phare Access, the patient access hub of R1's technology ecosystem. The system intelligently determines if an authorization is needed, automatically compiles and submits a complete request with the correct clinical documentation, and then proactively tracks the request until a decision is made and reflected in the patient's electronic health record (EHR).

A key feature is its “always-current” payer intelligence engine. This system continuously updates its rules based on policy changes across a vast network of insurance payers, which helps reduce errors and denials stemming from outdated information. By automating tasks like digital order submission, coverage verification, and status tracking, the platform aims to minimize the manual labor that bogs down provider staff.

However, the solution is not entirely hands-off. R1 emphasizes a “human-in-the-loop” model, where its technology is supplemented by a team of more than 1,600 authorization experts. This hybrid approach is designed to provide quality assurance and handle complex cases that AI cannot resolve alone, ensuring no patient orders fall through the cracks. The company suggests this comprehensive model can reduce a provider's total spend on authorizations by up to 50% compared to traditional methods.

Responding to a Shifting Regulatory Landscape

The launch is strategically timed as healthcare providers brace for sweeping new federal regulations. The Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule, published in early 2025, sets a 2026-2027 compliance deadline for major health plans to adopt electronic, API-based prior authorization processes.

This rule mandates significantly faster turnaround times—requiring Medicare Advantage and other plans to make standard decisions within seven days and expedited decisions within 72 hours, a sharp reduction from the previous 14-day timeline. Payers will also be required to provide specific reasons for any denials. R1's platform, with its focus on real-time data exchange and automation, is positioned as a tool for providers to not only adapt to but exceed these new federal standards.

While R1 is a major player, it enters an increasingly competitive field. Other technology firms like Waystar, Infinx, and Cohere Health are also offering AI-driven solutions to tackle the prior authorization challenge, signaling a decisive industry-wide shift away from manual processes. The market is responding to overwhelming demand from providers who, according to industry research from firms like KLAS, see automation as essential for improving staff efficiency, reducing denials, and achieving a positive return on investment.

From Administrative Burden to Accelerated Care

For healthcare providers, the benefits extend beyond mere compliance and cost savings. The administrative burden of prior authorizations is a significant contributor to staff burnout, with physicians and their teams often spending hours each week navigating payer requirements instead of focusing on patient care.

The impact of these efficiencies is already being felt by early adopters. “Partnering with R1 to modernize prior authorization has transformed the speed at which we can move patients into care,” said the Executive Director of Patient Access at a Florida-based health system with over $700 million in net patient revenue. “With R1’s automated, rules-based workflows, we’ve significantly reduced our system’s administrative burden, improved scheduling efficiency and reduced unnecessary friction for patients and referring providers. Today, more than 99% of our prior authorizations are cleared within three days.”

Ultimately, the goal of streamlining this process is to reduce the agonizing wait times patients often endure for necessary medical procedures and treatments. By converting a multi-day, manual process into a near-instant, automated one, the technology promises to directly improve the patient experience and access to care.

“R1 Prior Authorization sets a new standard, delivering the first zero-touch solution that enables secure, real-time automation at scale,” said Steve Albert, Chief Product Officer of R1. “We will continue to leverage R1’s unique combination of payer connectivity, automation and human expertise to deliver faster approvals and reduced denials, establishing R1 as the premium prior authorization provider.”