ASNC Argues for Guardrails on AI Use in Prior Authorization Decisions

ASNC’s delegates to the American Medical Association House of Delegates: Ahmet Oktay, MD (left), and Suman Tandon, MD, FASNC (right).

At the November 2025 American Medical Association (AMA) Interim House of Delegates meeting, ASNC Delegates Suman Tandon, MD, FASNC, and Ahmet Oktay, MD, argued in favor of Resolution 827, which opposed prior authorization in Medicare Fee-for-Service. ASNC believes physician expertise cannot be substituted with algorithms and there must be greater use of current evidence-based guidelines and peer-reviewed clinical literature.

After amendments, the resolution was adopted. It requires –

• The AMA to work with “stakeholders to advocate for great regulatory oversight related to the use of augmented intelligence [AI] for review of patient claims and prior authorization requests”;
• That any prior authorization review process includes physicians and other healthcare professionals who have expertise in the service under review and are not incentivized to deny care; and
• Transparency and accountability where AI denies services, including direct review of patient records by a qualified physician.

“Payers will be using AI technology to review prior authorization requests, which is why we need guardrails – to ensure that patients do not lose access to medically necessary care,” Dr. Oktay says. “It is an honor to represent ASNC at the AMA meeting and to advocate for patient-centered resolutions.”

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