Insights shaping the future of prior authorization, utilization management, and healthcare technology.
Explore expert perspectives, industry trends, product innovations, interoperability developments, AI advancements, and operational best practices from the teams helping modernize healthcare workflows across Health Plans, PBMs, and healthcare organizations.
How AI is reshaping prior authorization workflows.
Learn how AI-powered automation, OCR, NLP, and intelligent clinical review capabilities are helping organizations reduce manual work and improve operational efficiency.
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Streamlining Grievance Management: A Critical Tool for Health Plans & PBMs
With ongoing challenges such as the COVID-19 pandemic, rising healthcare costs, and changing regulatory requirements, healthcare organizations face increasing pressure to ensure efficient resolution of member grievances while maintaining compliance with industry...
Driving Efficiency & Compliance in Formulary Benefit Management
For Health Plans, PBMs, and TPAs, formulary management stands as a critical pillar in ensuring optimal patient care while managing costs effectively. As complexities surrounding formularies continue to mount, traditional approaches lack efficiency and are proving...
Enhancing MTM Programs: Impact of CMS’s 2025 Final Rule for Health Plans and PBMs
The recent final rule for the 2025 contract year issued by the Centers for Medicare & Medicaid Services (CMS) carries significant implications for Health Plans and Pharmacy Benefit Managers (PBMs) managing Medication Therapy Management (MTM) programs. This change...
Agadia Expands Suite of Healthcare Technology Solutions with the Launch of GrievancesHub
Parsippany NJ, April 2, 2024– Agadia, a leading provider of healthcare technology solutions, is pleased to announce the launch of GrievancesHub, a web-based Grievance Management solution designed to empower Health Plans and Pharmacy Benefit Managers (PBMs) in...
Improving Operational Efficiencies with Utilization Management Solutions
As our industry continues to evolve, efficiency, security, and adaptability are non-negotiables. Health plans, Pharmacy Benefit Managers (PBMs), and Third-Party Administrators (TPAs) need robust solutions that not only streamline operations but also ensure compliance,...
Unleash the Power of Prior Authorization Data with PAHub Insights
The need for effective Prior Authorization (PA) management for health plans, Pharmacy Benefit Managers (PBMs), and Third-Party Administrators (TPAs) continues to evolve. To propel your organization to new heights, it's not just about managing authorizations but...
Planning for the Future of Healthcare Legislation: Agadia’s Response to Colorado Revised Statutes
Planning for the Future of Healthcare Legislation: Agadia's Response to Colorado Revised Statutes When it comes to healthcare legislation, staying ahead is not just a necessity; it's our commitment at Agadia. As of February 20, 2024, the Colorado Revised Statutes...
Navigating Prior Authorization Reforms Across Multiple States: A State of Change
In response to escalating concerns voiced by providers and patients regarding delayed and denied care, an increasing number of states are taking decisive steps to impose limitations on prior authorization (PA) requirements. These legislative efforts, reaching beyond...
Navigating the CMS Interoperability & Prior Authorization Final Rule
The healthcare landscape is undergoing a transformative shift with the introduction of the Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule (CMS-0057-F). This comprehensive regulation sets forth a series of...
Biden-Harris Administration Propels Transparency in Medicare Advantage: What Health Plans and PBMs Need to Know
The Biden-Harris Administration's recent announcement on promoting competition in healthcare includes a significant focus on increasing transparency in the Medicare Advantage (MA) insurance market. The U.S. Department of Health and Human Services (HHS) and the Centers...