AI-Powered Automation for Modern Utilization Management
A unified suite of intelligent utilization management solutions, spanning prior authorization, formulary management, MTM, Star Ratings and Grievances/Appeals — designed to simplify compliance, accelerate decisions, and help health plans, PBMs, and healthcare organizations scale with confidence.
Next-Gen Utilization Management Solutions:
AI-Powered, Expert-Driven. Keeping Humans in the Loop.
Automate Prior Authorization
A seamless enterprise platform leveraging AI & automation for medical & pharmacy prior authorizations. HL7 & FHIR ready.
Formulary Benefit Management
Control the creation, implementation and maintenance of custom and standard formularies.
Grievances & Appeals
Manage and resolve member grievances efficiently, while also ensuring compliance with CMS requirements.
Part D Star Ratings & Adherence
Design and manage clinical programs to achieve higher clinical & formulary compliance
Medication Therapy Management
Efficiently Manage & Implement MTM Programs to Meet these CMS Requirements
Hub Services
Enabling Hubs, Specialty Pharmacies, and Drug Manufacturers to access APIs or an ePA portal to streamline the prior authorization process.
Why Choose Agadia?
Beyond a Vendor: Your Trusted Business Partner in Healthcare Innovation
We proudly go beyond traditional vendor relationships by continuously investing in the evolution of our solutions. We proactively implement global enhancements driven by new CMS regulations, industry requirements, and emerging technological trends, ensuring our clients stay ahead in an ever-changing healthcare landscape.
Agadia partners closely with each customer to understand their operational goals, compliance priorities, and evolving business needs. Through dedicated account support, ongoing collaboration, and customer-driven product enhancements, we help organizations optimize utilization management performance while adapting to new regulations, market demands, and opportunities for automation.
Increased Processing Speed by
133%
For Prior Authorizations Using PAHub
Explore How a Health Plan
Specializing in State Medicaid
Doubled Their Prior Authorization Volume
with an actual reduction in staff, and increased their processing speed by more than 133%
What our clients are saying
Trusted By Leading Health Plans & PBMs
“Agadia has been pivotal in our go-to-market strategy—both from a product stand-point as well as strategic leadership demonstrated by their team.” — VP, IT
First Year IRR of
199%
While Using PAHub
Learn how a Health Plan with both commercial and medicare business
Saw an Internal Rate of Return of 199%
within one year of using PAHub
OUR MISSION
Agadia is dedicated to
improving the quality of care and expediting the delivery of health care services by advancing and automating utilization management processes.
What Our Clients Are Saying
"Agadia has been a fantastic partner for several years. As MedOne has grown as a market leader in medication stewardship, we have directly benefited from the efficiencies afforded through the PAHub platform. We would not have been able to enhance the level of care we provide to our members while scaling our operations without the support of the Agadia software and team." - Dr. Nathan Harold, RPh, PharmD., MedOne
"I wanted to pass along that the CDAG portion of our CMS audit last week went well and complement Agadia on the PAHub systems display. The ease of navigation through the full report helped us display the information very smoothly and precisely which is often half the battle in a CMS audit." - Manager - PBM
"I just wanted to drop a quick note letting you know how well PAHub has worked out for us. It has been instrumental in ensuring compliance with various regulations and increased the overall productivity of the Clinical staff. This is a terrific product that has allowed CMS audit events to go very smoothly. Thank you for helping us be successful!" - A.P.; SVP PBM
"Agadia has consistently lead product development with out-of-the-box thinking focusing on a replicable feature-sets to reduce our overall cost of ownership. Their commitment to project management best practices has allowed us to prioritize tactically and avoid potential budget escalations. Agadia’s growing market foot-print clearly demonstrates their commitment to innovation in the healthcare IT space and have been phenomenal to work with." - VP, PBM
In the News
PRESS RELEASE: Agadia Systems, Inc. and SelectHealth Announce Agreement to Assist with Prior Authorization Services for SelectHealth
PARSIPPANY, N.J. and Murray, UTAH – May 10, 2016 - Agadia Systems, Inc. (Agadia), noted for its ability to improve the quality of care and deliver innovative utilization management solutions, and SelectHealth, a not-for-profit health insurance organization serving...
Join Agadia for a Free Webinar on Electronic Prior Authorization
Agadia is pleased to participate in the following webinar presented by Surescripts on April 5th, 2016 at 11AM ET. Join us as we explore the key benefits of automated ePA management, and discover how our solution, PAHub, helps to complete the process. CompletEPA -...
PRESS RELEASE: Agadia Announces New Healthcare Technology Solutions in MTM and Part D Star Ratings & Adherence
PARSIPPANY, NJ – March 10, 2016 – Agadia, a healthcare management technology company known for the leading Prior Authorization solution, PAHub, has announced the expansion of their reputable suite of utilization management solutions, RxContinuum, to include software...
Headcounts Likely Will Shift, Shrink Amid Insurers’ Strategic Reviews of Admin Costs
The AIS Health Plan Week issue dated December 21, 2015 featured the following article, Headcounts Likely Will Shift, Shrink Amid Insurers' Strategic Reviews of Admin Costs. Early December brought news that Blue Cross and Blue Shield of Michigan is preparing to cut...
CMS May Adjust Medicare Advantage Star Ratings for Demographic Characteristics
Andy Slavitt, the acting administrator of the US Centers for Medicare and Medicaid Services (CMS), told health plans at an America’s Health Insurance Plans (AHIP) conference last week that the agency may change how it calculates Medicare Advantage (MA) star ratings....
ExpressPath: Powered by Agadia’s Prior Authorization software, PAHub
Agadia is garnering recognition through the work done with its clients on the leading edge of healthcare IT. The platform described in this award announcement, was built by Agadia using its PAHub and integrated Doctor Portal solutions, enhanced in cooperation with...
