Uploaded September 2025 | Updated September 2026, 2 weeks ago
From complexity to clarity—learn how to streamline DTR workflows and harness AI for faster, fairer prior authorization decisions.
Abstract:
Even with CMS‑0057 and the Da Vinci DTR Implementation Guide, documentation burdens still hold back electronic prior authorization. In this session, Optum’s Stephan Rubin shows how to make DTR practical by digitizing medical policies, giving clinicians tools to gather the right information, and streamlining workflows. Next, Anna Taylor (MultiCare) hosts a discussion with Julie Smith (InterSystems), Danny Cawood (MCG Health) and Joe Ellis/Stephan Rubin (Optum). Julie explains why clean, well‑organized data is essential for scalable automation. Together the panel explores how high‑quality data and artificial intelligence can replace some CQL logic, standardize documentation templates and gold‑carding programs, and turn prior authorization from a compliance task into a process that boosts efficiency, fairness and patient care. You’ll leave with clear steps to translate mandated APIs into real operational and clinical improvements.
Key takeaways:
Healthy data is the fuel for automation: Why comprehensive, clean, deduplicated clinical data—both structured and unstructured—is essential for scalable ePA and value‑based care.
Digitizing medical policy & simplifying DTR: How Optum’s InterQual team helps plans and providers digitize guidelines, normalize documentation requirements and build tools that surface necessary items before submission.
AI‑powered adjudication, beyond CQL: When AI can replace or augment CQL for faster, more adaptive rules processing—and where a human in the loop remains crucial.
Standardization & gold carding: How aligning on documentation templates, rules and “gold carding” programs reduce unnecessary requests and rewards high‑quality providers.
Culture change & governance: Why new technologies demand new organizational behaviors—collaboration across payer, provider, EHR and UM teams, opt‑out pathways for edge cases, and open data governance.
Speakers
Stephan Rubin — Director of Product Management, Optum
Anna Taylor — AVP, Population Health & Value‑Based Care, MultiCare Connected Care (Moderator)
Danny Cawood — Senior Manager, Product Management, MCG Health
Julie Smith — Senior Manager, Product Management, InterSystems
Joe Ellis — Senior Director, AI Product Management, Optum
intersystems.com
From complexity to clarity—learn how to streamline DTR workflows and harness AI for faster, fairer prior authorization decisions.
Abstract:
Even with CMS‑0057 and the Da Vinci DTR Implementation Guide, documentation burdens still hold back electronic prior authorization. In this session, Optum’s Stephan Rubin shows how to make DTR practical by digitizing medical policies, giving clinicians tools to gather the right information, and streamlining workflows. Next, Anna Taylor (MultiCare) hosts a discussion with Julie Smith (InterSystems), Danny Cawood (MCG Health) and Joe Ellis/Stephan Rubin (Optum). Julie explains why clean, well‑organized data is essential for scalable automation. Together the panel explores how high‑quality data and artificial intelligence can replace some CQL logic, standardize documentation templates and gold‑carding programs, and turn prior authorization from a compliance task into a process that boosts efficiency, fairness and patient care. You’ll leave with clear steps to translate mandated APIs into real operational and clinical improvements.
Key takeaways:
Healthy data is the fuel for automation: Why comprehensive, clean, deduplicated clinical data—both structured and unstructured—is essential for scalable ePA and value‑based care.
Digitizing medical policy & simplifying DTR: How Optum’s InterQual team helps plans and providers digitize guidelines, normalize documentation requirements and build tools that surface necessary items before submission.
AI‑powered adjudication, beyond CQL: When AI can replace or augment CQL for faster, more adaptive rules processing—and where a human in the loop remains crucial.
Standardization & gold carding: How aligning on documentation templates, rules and “gold carding” programs reduce unnecessary requests and rewards high‑quality providers.
Culture change & governance: Why new technologies demand new organizational behaviors—collaboration across payer, provider, EHR and UM teams, opt‑out pathways for edge cases, and open data governance.
Speakers
Stephan Rubin — Director of Product Management, Optum
Anna Taylor — AVP, Population Health & Value‑Based Care, MultiCare Connected Care (Moderator)
Danny Cawood — Senior Manager, Product Management, MCG Health
Julie Smith — Senior Manager, Product Management, InterSystems
Joe Ellis — Senior Director, AI Product Management, Optum
intersystems.com
