Why Efficiency is a Global Clinical Safety Concern

Administrative burdens are common everywhere; automation results in measurable savings. The CAQH Index suggests that digitizing and automating complex U.S. transactions could save over $15 billion annually, primarily by eliminating manual steps related to eligibility, status, and authorization.

Meanwhile, policy changes are gaining momentum: the CMS Interoperability & Prior Authorization Final Rule establishes API and turnaround time requirements (standard prior authorization in 7 days; 72 hours for expedited) with significant deadlines in 2026–2027 for affected payers—prompting process redesign now.

Worldwide, the adoption of digital health remains a top priority across regions (EU/WHO), but capacity limitations mean tools that reduce administrative friction have a substantial impact.

Where AI Provides the Most Benefit (and How Glean Fits In)

1) Knowledge Flow in Work (Search + Assistant)

Medical professionals and administrative teams waste time searching for policies, payer bulletins, referral and prior-auth steps, and runbooks. Glean indexes approved sources (SharePoint/Google Drive/Confluence; ServiceNow/Salesforce/Zendesk) and delivers permission-aware answers with references in Teams/Slack and ticket sidebars—reducing escalations and response times.

2) Fewer Avoidable Denials (Agents + Revenue Cycle Checks)

Many denials result from documentation gaps and policy inconsistencies. AI agents can pre-check draft claims against payer rules, highlight missing elements, and route complex cases for human review—improving clean-claim rates and cash flow. CAQH’s data highlights the financial benefits of automating these transactions.

U.S. Context: Align pre-submission checks to CMS prior-auth and attachment workflows so providers aren’t hindered by the 7-day/72-hour timelines as APIs are deployed.

3) Staff Self-Service and Service Operations

From IT/HR inquiries to facilities and schedule questions, AI reduces repetitive queries and speeds up triage, allowing clinicians to spend more time on patient care.

Security, Privacy, and Regional Compliance (Board-Ready)

• Foundational Controls: Glean publishes security practices and certifications (SOC 2 Type II, ISO 27001) and states compliance with HIPAA and GDPR, ensuring results respect source access with permission-mirroring.
  
  

• United States (HIPAA): Consider Business Associate agreements, map safeguards to Privacy/Security Rules, and monitor the 2025 NPRM proposing stricter controls (e.g., MFA, encryption, incident response).

• Canada (PHIPA/PIPEDA): For Ontario providers/insurers, PHIPA AMPs are now applicable; PIPEDA is applicable to private-sector personal information processing nationwide—align audit trails and consents.

90-Day Rollout (Global Pattern You Can Localize)

Phase 1 — Foundation (Weeks 1–3)

• Prioritize journeys: top denial reasons, top prior-auth procedures, top 50 staff queries.

• Connect core sources (M365/SharePoint, Confluence, ServiceNow, Salesforce, Zendesk).

• Enable citations and permission sync; define retention/telemetry behaviors per region.

Phase 2 — Assist In-Flow (Weeks 4–8)

• Deploy the assistant in Teams/Slack and ticket sidebars.

• Launch two agents: (1) prior-auth checklist builder; (2) claim/charge pre-submission audit. Track clean-claim %, interactions per claim, and turnaround.

Phase 3 — Govern & Scale (Weeks 9–12)

• Adopt an “AI Formulary”: approved prompts, data sources, exception pathways.

• Map evidence to HIPAA/PHIPA/PDPL artifacts and—where relevant—CMS prior-auth reporting.

Example Impact by Workflow

FAQs

How does AI streamline healthcare operations?
By reducing search time and automating routine checks. Staff receive trusted answers on-the-spot, while agents validate authorizations and claims in advance—freeing up capacity for patient care. docs.glean.com+1

What role does AI play in reducing denials?
Most denials are due to documentation and policy inconsistencies. AI agents identify gaps before submission and conform to payer rules, enhancing clean-claim rates and speeding up reimbursement. caqh.org

Is AI adoption secure in healthcare settings?
Absolutely—when accompanied by strong controls. Glean documents SOC 2/ISO practices and aligns with HIPAA/GDPR, while regional laws (PHIPA, PDPL) demand auditable access and governance with evidence. LawNow+3Glean+3Glean+3

Summary

Throughout regions, the quickest gains are administrative: access the right information on-the-spot, avoid unnecessary denials, and diminish repetitive queries. Glean’s Work AI platform achieves these goals with permission-aware search, assistants, and targeted agents—encompassed within controls that compliance teams can verify under HIPAA/PHIPA/PDPL. Ready to customize a rollout? Let’s talk.