AI Security for Prior Authorization: HIPAA, State Laws, and the Identity-Bound Decision Record
Prior authorization is the highest-volume AI use case inside payer organizations and a growing one inside health systems. The compliance stack covers HIPAA, the new state utilization-review laws (California SB-1120, Texas SB-815, Colorado SB 26-189), and the ongoing CMS scrutiny of AI denial patterns. This article walks through the identity, classification, and audit requirements specific to prior authorization, the failure modes documented in recent enforcement actions, and the gateway-layer controls that produce decision records the regulators have started asking for.
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