Episode
Leveraging AI Solutions to Modernize Prior Authorization in Medical Practices, with Dr. Paola Ballester
- Podcast
- MGMA Podcasts
- Published
- Dec 10, 2025
- Duration seconds
- 1843
- Processing state
not_requested- Canonical source
- https://mgma-podcasts.transistor.fm/743
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Summary
In this episode of the MGMA Insights Podcast , Sr. Editor and host Daniel Williams sits down with Paola Ballester, MD , pediatric hospitalist, medical director for utilization management, and senior physician advisor at a large, freestanding academic children’s hospital and regional pediatric referral center. Dr. Ballester is also the co-founder of EasyPA, an AI-driven platform designed to streamline prior authorization processes. Together, they explore how medical practices can tackle administrative burdens, leverage technology, and prepare for upcoming regulatory changes — all while improving patient access to care. Key Takeaways 02:45 Dr. Ballester’s Unique Journey From insurance claims adjuster to pediatric hospitalist — how her background shaped her expertise in utilization management and revenue cycle. 06:27 The Pain Points of Prior Authorization Why delays in prior auth lead to patient suffering and staff frustration, and why the current system is broken. 08:01 Introducing EasyPA How an AI-powered platform can detect prior auth requirements, reduce denials, and generate appeal letters and peer-to-peer talking points. 11:37 The “220-Minute Case” A real-world example of administrative burden: 19 email threads, 14 team members, and multiple failed appeals for one procedure. 22:19 Preparing for Regulatory Changes CMS’s new rules (57F) will require electronic prior auth by Jan 1, 2027 — what practices need to know now. 17:22 Choosing the Right Tech Tools Practical advice for administrators and clinicians on evaluating AI solutions and understanding your own data before investing. 24:22 Leadership and Representation Dr. Ballester’s advice for women in healthcare leadership: owning confidence, overcoming imposter syndrome, and defining success. 26:35 Life Beyond Medici…