Regulation of AI in Prior Authorization and Claims Review: A Look at Federal and State Consumer Protections Authors: Kaye Pestaina, Rayna Wallace, Justin Lo, and Michelle Long Published: May 6, 2026

https://www.kff.org/patient-consumer-protections/regulation-of-ai-in-prior-authorization-and-claims-review-a-look-at-federal-and-state-consumer-protections/?utm_campaign=KFF-Private-Insurance&utm_medium=email&_hsenc=p2ANqtz-9sDxEnpwI6Lwy4_jm_9zIx2IlkUU6dKJh1cir9_wW1bgIJ86aS0-ISB9apl7Ygsdoh1aG4mLTL4-UQzDLu65imIzWCSQ&_hsmi=417520503&utm_content=417520503&utm_source=hs_email KFF Examines AI’s Role in Claims Review and Prior Authorization Rapid technological developments in artificial intelligence (AI) have led to increased use in health care, including to submit and review insurance claims, prior authorization requests, and appeals. A new KFF brief brief explores how health plans, providers, and patients are using AI to process the paperwork that determines when services are covered and assesses the risks and benefits for consumers. It also examines the Trump administration’s proposed “National Policy Framework for Artificial Intelligence,” which recommends preempting state consumer protection laws—such as those that ban AI from being the sole decision-maker on adverse determinations—in order to create uniform national standards. It reviews the current landscape of federal and state consumer protections, including state laws addressing AI and claims review. Contact: Craig Palosky | 202.654.1369 | CraigP@kff.org