Agadia PAHub is an end-to-end, fully configurable, HITRUST-certified, web-based solution for Utilization Management, specifically focusing on Prior Authorization (PA) management for Health Plans, Pharmacy Benefit Managers (PBMs), and Third-Party Administrators (TPAs). The platform unifies the PA process for both medical and pharmacy benefits, eliminating the need to manage separate systems.
Key Features and Capabilities:
- Automation & Efficiency: The platform leverages advanced AI, Machine Learning, and Natural Language Processing (NLP) to drive automation. This includes an Auto-Decisioning Rules Engine that uses data mining across enterprise systems to electronically adjudicate requests, which can significantly reduce turnaround times and administrative costs.
- Fax Data Extraction: Utilizes AI/NLP-powered Fax Data Extraction to convert unstructured fax data into structured digital data, reducing manual data entry and improving accuracy.
- Comprehensive Support: Supports all lines of business (Commercial, Medicare, Medicaid) and all channels (electronic prior authorization (ePA), phone, fax, web, EMR integrations).
- Compliance: Features Continuous Compliance Surveillance Channels and is designed to ensure adherence to CMS and state mandates, including Medicare Part D guidelines.
- User Portals & Insights: Includes the PromptPA self-service portal for providers and members to request PAs and check status, and PAHub Insights for rich visual dashboards and self-service ad hoc reporting to enable data-driven decision-making.
PAHub is utilized by some of the nation's largest Health Plans and PBMs to streamline the PA process, increase operational efficiencies, and ensure regulatory compliance.
