Fears of Payer AI Use in Auditing Loom as Providers Establish Their Own AI Tools
By Ashleigh Hollowell | September 29, 2026
Photo by Markus Spiske on Unsplash
Share
This is an exclusive BHB+ story.
More than half of the nation’s mental health clinicians now use AI tools in their professional workflows, ranging from administrative tasks to training and note-taking. However, behavioral health providers are growing anxious about what payers' AI use and adoption may mean for them, especially concerning audits.
Multiple providers share their concerns with Behavioral Health Business, stating that AI could intensify audit processes and introduce unprecedented levels of scrutiny. As payers develop their AI capabilities, providers are expected to do the same, potentially leading to a competitive battle of outdoing each other's AI tooling.
"I think AI in the use of audits is inevitable," said Andy Kelly, Chief Commercial Officer at Boulder Care. "I think more and more we’ll see payers... reduce prior authorizations, which we don’t have to deal with directly. But they won’t reduce them without looking [at data and patterns]. I think there will be more back-end audits... but I also think the tools that providers will either build or purchase will rise to the occasion."
Boulder Care, a digital addiction treatment provider with operations in seven states, acknowledges the challenge. However, some smaller providers worry they'll be at a disadvantage as payers generally possess greater resources and revenue for AI investment.
"Because of AI, payers can look at auditing and claims in a much deeper and broader way," noted Colleen Marshall, Chief Clinical Officer at Two Chairs. "In the past, we might send 10 charts a quarter, and the payer would use that to evaluate the quality of your charts. Now they can look at many more charts and with far greater depth."