Application of artificial intelligence-based software for health insurance prior authorization approval in medical diagnostics and interventions

A system for assessing prior authorization approval, the system comprising one or more computer processors, and a memory having stored therein machine executable instructions, that when executed by the one or more processors, cause the system to:

• receive, via a device connected to a network via one or more servers, a prior authorization approval request;
• receive, via one or more servers, data from one or more previous prior authorization decisions, documentation, and socioeconomic variables,
• wherein at least a portion of the documentation is received from the prior authorization approval request;
• receive, via the one or more servers, data from one or more expert or peer review opinions;
• receive, via the one or more servers, imaging data,
• wherein the imaging data includes one or more of medical imaging, histologic pathology, or serology data;
• determine, via the one or more servers, an extent of disease of a patient based at least on the imaging data;
• adjust, via the one or more servers, one or more prior authorization decision-making parameters based on the one or more expert or peer review opinions, previous prior authorization decisions, documentation, socioeconomic variables, and imaging data;
• and
• generate, via the one or more servers, a likelihood of prior authorization approval.

A computer-readable storage medium having data stored therein representing software executable by a computer, the software having instructions to:

• receive, via a device connected to a network via one or more servers, a prior authorization approval request;
• receive, via one or more servers, data from one or more previous prior authorization decisions, documentation, and socioeconomic variables,
• wherein at least a portion of the documentation is received from the prior authorization approval request;
• receive, via the one or more servers, data from one or more expert or peer review opinions;
• receive, via the one or more servers, imaging data,
• wherein the imaging data includes one or more of medical imaging, histologic pathology, or serology data;
• determine, via the one or more servers, an extent of disease of a patient based at least on the imaging data;
• adjust, via the one or more servers, one or more prior authorization decision-making parameters based on the one or more expert or peer review opinions, previous prior authorization decisions, documentation, socioeconomic variables, and imaging data;
• and
• generate, via the one or more servers, a likelihood of prior authorization approval.