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
Agadia Systems, Inc. Announces Integration with CQ fluency within Prior Authorization Solution, PAHub.
Agadia Systems, Inc. Announces Integration with CQ fluency within Prior Authorization Solution, PAHub. PARSIPPANY, N.J. – Sept 7, 2022- Agadia Systems, Inc. (Agadia), a recognized healthcare technology solution provider for over 50 of the nation’s leading...
Electronic Prior Authorization for Drugs Covered Under the Medical Benefit (eMPA)
Electronic Prior Authorization for Drugs Covered Under the Medical Benefit From Agadia's White Paper CollectionElectronic Prior Authorization for Drugs Covered Under the Medical BenefitPAHub - An end-to-end electronic PA solutionOver the last several years, the volume...
Agadia Systems, Inc. Announces Agreement with Blue Cross and Blue Shield of Kansas City for use of Agadia’s Electronic Prior Authorization Solution, PAHubTM.
PARSIPPANY, N.J. – Feb 18, 2021- Agadia Systems, Inc. (Agadia), a recognized healthcare technology solution provider for Health Plans & PBMs is announcing an agreement with Blue Cross and Blue Shield of Kansas City (Blue KC), to utilize PAHub, Agadia’s HITRUST...
PRESS RELEASE: Agadia Launches New Healthcare Technology Solution to Shift the Paradigm of Formulary Benefit Management.
PARSIPPANY, NJ – July 15, 2020 – Agadia, a healthcare management technology company widely known for innovations in Utilization Management software, has announced the expansion of their suite of solutions to include FormularyHub, an RxContinuum SolutionTM, a fully...
Agadia Systems, Inc. Announces Agreement with WellDyne for use of Agadia’s Prior Authorization Solution, PAHub
Agadia Systems, Inc. Announces Agreement with WellDyne for use of Agadia’s Prior Authorization Solution, PAHub. PARSIPPANY, N.J. – May 4, 2020- Agadia Systems, Inc. (Agadia), a well-recognized innovator and provider of the utilization management suite of solutions,...
Press Release: Electronic Prior Authorization Case Study by Agadia Results in a 50% Decrease in PA Phone Volume
PARSIPPANY, N.J., Jan. 13, 2020 /PRNewswire/ -- In today's market, healthcare stakeholders are continually pressured to improve current prior authorization processes by limiting the use of outdated PA channels, such as phone or fax, and instead gravitating towards the...
