AI in Prior Authorization Quiz

Answers and explanations appear as you take the quiz.

1. What is prior authorization?
   • A patient's consent form for surgery
   • A process in which a health plan must approve certain services before it pays for them
   • A hospital's internal scheduling system
   • A government license for doctors
2. What does the HL7 Da Vinci project provide?
   • A proprietary insurer denial algorithm
   • A federal law on insurance coverage
   • A medical imaging standard
   • FHIR-based workflows for checking coverage requirements, collecting documentation and submitting requests
3. The class action involving naviHealth's nH Predict tool concerned what type of care?
   • Post-acute care in Medicare Advantage
   • Emergency surgery
   • Prescription eyeglasses
   • Dental cleanings
4. What does it mean that payer-side automation is often 'asymmetric by design'?
   • It denies all requests by default
   • It only works for large hospitals
   • It auto-approves clear requests while routing uncertain or adverse cases to clinicians
   • It processes requests in random order
5. What did CMS tell Medicare Advantage plans about algorithms?
   • Algorithms must make all coverage decisions
   • Algorithms cannot be the sole basis for denying care without considering the individual patient
   • Algorithms are banned entirely
   • Algorithms may only be used for dental care
6. The Prior Authorization Support guide maps FHIR requests to which transaction required under HIPAA?
   • DICOM
   • HL7 v2 ADT
   • ICD-10
   • X12 278
7. What is gold-carding?
   • Exempting clinicians with high approval rates from some prior authorization reviews
   • A premium insurance plan for wealthy patients
   • A credit card used to pay copays
   • A penalty for clinicians with many denials
8. According to the guide, what failure mode have regulators targeted?
   • Using FHIR instead of fax
   • Publishing prior authorization metrics
   • Treating a predicted length of stay as if it were a coverage determination
   • Auto-approving requests that meet criteria