Agadia is a leading healthcare technology company that offers a comprehensive suite of Utilization Management (UM) solutions for Health Plans, Pharmacy Benefit Managers (PBMs), and Third-Party Administrators (TPAs). The core of their offering is the PAHub platform, a HITRUST-certified, cloud-based solution designed to streamline and automate the entire prior authorization (PA) workflow for both pharmacy and medical benefits.
Key Features and Capabilities
- Electronic Prior Authorization (PAHub): An end-to-end, fully configurable, web-based solution that automates PA workflows, supporting all lines of business (Commercial, Medicare, Medicaid) and channels (ePA, phone, fax, web, EMR integrations).
- AI/NLP-powered Fax Data Extraction: Leverages machine learning and Natural Language Processing (NLP) to extract key information from incoming faxes, converting it to structured digital data within PAHub to reduce manual data entry and improve accuracy.
- Auto-Decisioning Rules Engine: Increases automation by using data mining techniques across enterprise systems to electronically adjudicate prior authorization requests.
- Medication Therapy Management (RxMTM+): A platform for clinical interventions to optimize patient outcomes and medication adherence.
- Grievance Management (GrievancesHub): A web-based solution for efficiently managing and resolving member grievances while ensuring compliance with CMS requirements.
- Part D Star Ratings & Adherence (RxSentinel+): Solutions to help clients improve their Medicare Part D Star Ratings and medication adherence programs.
- Rich Visual Dashboards (PAHub Insights): Provides operational and managerial insights with interactive reports, self-service ad hoc reporting, and drill-down capabilities powered by tools like Microsoft Power BI.
Target Users and Use Cases
Agadia's solutions are primarily used by large Health Plans, PBMs, and TPAs to drive operational efficiency, ensure regulatory compliance (especially with CMS mandates), and reduce administrative costs. Specific use cases include:
- Automating the prior authorization process for specialty drugs via the PromptPA portal.
- Achieving and maintaining compliance with complex regulations like HIPAA and CMS audit requirements.
- Improving the speed of patient access to therapy by reducing PA turnaround times.
- Managing and resolving member appeals and grievances efficiently.
