Electronic Prior Authorization Process & Automation Software

Improve Clinical Efficiency & Compliance with Agadia’s fully customizable web-based solution, PAHub.

prior auth solution

End-to-End Management of Electronic Prior Authorizations

Delivering Electronic Prior Authorization Efficiency & Compliance

As Prior Authorization volumes continue to rise, and as specialty drugs create additional clinical complexities, Health Plans, Pharmacy Benefit Managers (PBMs) and Third-Party Administrators (TPAs) are challenged to adapt while maintaining or improving operational and clinical efficiencies. PAHub, is a HITRUST certified solution that puts the tools at your fingertips to streamline and control all clinical, compliance and administrative aspects of Prior Authorization at the point-of-care to improve compliance, reduce turn-around times and costs.

By leveraging the latest technologies for data mining, data analytics, content management and advanced decision support trees, PAHub, enables customers to automate the end-to-end prior authorization process.

All Lines of Business

Supported across all lines of business (commercial, Medicare, Medicaid, etc.)

All Channels

Available across all channels (electronic prior authorization (ePA), phone, fax, web, e-prescribing, etc.)

All Healthcare Services

Applicable for all healthcare services, all benefit types (pharmacy & medical)

A Centralized Prior Authorization Solution

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Continually Innovating to Meet Industry Needs

Addressing Electronic Prior Authorization for Drugs Under the Medical Benefit

With an influx of infused medications being administered in physician offices, prior authorizations for drugs billed under the medical benefit are presenting challenges across the industry. While there is an industry NCPDP SCRIPT standard for electronic prior authorization (ePA) for drugs billed under the pharmacy benefit, driving significant ePA volume, an industry standard does not currently exist for drugs under the medical benefit.

medical benefit prior authorization
The challenge with adopting the NCPDP SCRIPT standard for drugs under the medical benefit is that these medications typically do not go the standard route of provider e-prescribing to a traditional retail or mail-order pharmacy location. Often times, the specialty medications are being purchased by the provider (physician/infusion center) directly from drug distributors and administered in the office setting. As a result, health plans continue to receive the drugs under the medical benefit prior authorization requests via phone, fax, or portal which is placing an enormous administrative burden on the health plans operations team, provider office, and the patient.

Agadia continues to innovate and has addressed these challenges by providing eMPA capabilities to reduce the prior authorization administrative burden through a more efficient channel that increases automation and improves turnaround times. Providers will benefit by quickly being informed whether the drug is under the pharmacy or medical benefit, allowing them to efficiently manage requests. Hub companies will experience improved efficiencies as well such as faster turnaround times for a prior authorization decision, improved patient speed to therapy and better adherence.

Leverage Advanced Technologies

Save Valuable Time & Resources with PAHub’s Auto-Decision

PAHub’s Auto-Decision rules engine increases automation be leveraging data mining techniques across enterprise systems data to electronically adjudicate prior authorization requests. Auto-Decision helps a customer to allocate staff to high-touch requests instead of requests that can be adjudicated automatically.

Engage Pharmacies, Members & Providers

In the Prior Authorization and Pre-Certification Process

PromptPA is a self-service, web based solution that enables our customers’ pharmacies, members and providers to request prior authorizations electronically, initiate renewals and check the status of requests using any web browser, reducing operational costs and call volume to Health Plans and Benefit Managers.

 

Quick Facts

Lives Covered Across Customer Base

Health Plan & Pharmacy Benefit Management (PBM) & Third-Party Administrator (TPA) Customers

Prior Authorizations Processed Annually

%

Electronic Prior Authorizations Processed

Case Studies

Explore the potential benefits you can achieve with PAHub

The following case studies reveal how one Health Plan benefited from an ePA implementation, another doubled their PA volume with a reduction in staff, and one saw an IRR of 199% within the first year of using PAHub.

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Prior Authorization Increased Processing Speed

Phone

877-575-2533

Email

contact@agadia.com

Location

9 Campus Drive, Parsippany NJ 07054

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