Summary
Establishes AMA policy opposing autonomous or semiautonomous AI as a substitute for qualified physician review in coverage determinations and supporting evidence-based criteria, meaningful physician oversight, transparency, appeals, continuity of care, and regulatory guardrails for AI-supported prior authorization.
Healthcare Implications
Payers and utilization-management vendors should keep physicians involved in consequential coverage decisions, disclose and maintain current decision criteria, support timely review and appeal, and ensure automated systems do not independently deny or delay medically necessary care.