Prior authorization (PA) is widely used to manage utilization of high-cost health services, yet it imposes administrative burdens and can delay care. As generative AI is increasingly deployed to automate both the submission of prior authorization requests by providers and authorization decisions by insurers, raising questions about the effectiveness of gatekeeping as a utilization management strategy in the AI era. This project studies whether an alternative lever—provider-level audits—can reduce administrative burden while preserving oversight for utilization management. We examine a “gold-carding” policy that exempts providers with low historical denial rates from prior authorization while conditioning continued exemption on periodic audits of ordering behavior.…Read More