A Smarter Partner for Utilization Management
Agadia delivers a unified, enterprise-grade platform designed to modernize utilization management across medical and pharmacy benefits — helping health plans and PBMs improve efficiency, ensure compliance, and deliver better care outcomes.
Agadia is purpose-built for the complexity of payer and PBM operations.
Healthcare organizations are under pressure to improve speed, transparency, and outcomes while keeping pace with evolving regulatory requirements. Agadia helps clients move from fragmented, manual processes to a connected, intelligent utilization management environment.
Our platform supports complex workflows across medical and pharmacy benefits, multiple lines of business, diverse integration needs, and configurable plan-specific policies.
All Lines of Business
Support Commercial, Medicare, Medicaid, Exchange, and other plan-specific operating models.
All Benefit Types
Coordinate medical and pharmacy utilization management through unified workflows.
Real-Time Configuration
Adapt workflows, criteria, rules, letters, notifications, and reporting without waiting on vendor delivery.
One platform. Complete utilization management coverage.
Agadia offers a full suite of solutions that work together to support utilization management, clinical programs, quality initiatives, and operational performance.
PAHub
End-to-end prior authorization management across medical and pharmacy benefits.
Formulary Management
Support formulary operations, clinical criteria, and plan-specific medication strategies.
Medication Therapy Management
Support MTM programs that improve medication use, adherence, and outcomes.
Star Ratings & Quality
Enable quality improvement efforts, performance tracking, and program visibility.
Grievances & Appeals
Manage case intake, tracking, resolution, and compliance timelines.
Why organizations choose Agadia over point solutions and legacy platforms.
Point Solutions
Often solve one narrow workflow but create fragmentation across teams, benefits, and reporting.
- Limited scope
- Separate systems
- Disconnected reporting
- More operational handoffs
Agadia
A unified platform that supports end-to-end utilization management with configurability, automation, compliance, and enterprise scalability.
- Medical + pharmacy workflows
- Full suite of UM solutions
- Real-time configuration
- Automation + interoperability
- Compliance and audit readiness
Legacy Platforms
May offer breadth, but often require heavier implementation cycles and slower adaptation to changing requirements.
- Complex configuration
- Longer update cycles
- Rigid workflows
- More dependency on vendor delivery
Modernize operations without losing control.
Intelligent Automation
Reduce administrative burden with AI-enabled intake, document processing, workflow routing, and decision support.
Interoperability-Ready
Support electronic prior authorization, FHIR-based workflows, APIs, EHR connectivity, and payer-provider data exchange.
Actionable Reporting
Improve visibility into approvals, denials, turnaround times, utilization patterns, and operational performance.
Configurable Workflows
Configure rules, decision trees, letters, users, roles, notifications, turnaround timers, and plan-specific requirements.
Compliance Built In
Support CMS, state, audit, and operational compliance requirements with transparency and documentation.
Partnership Model
Dedicated support, implementation guidance, training, and ongoing consultative partnership beyond go-live.
Designed for regulatory change and audit readiness.
Agadia helps organizations stay ahead of evolving CMS and state requirements with configurable workflows, reporting, documentation, and ongoing product enhancements.
PAHub supports organizations preparing for CMS-0057-F, electronic prior authorization, FHIR-based interoperability, and the broader shift toward more transparent, measurable utilization management.
HITRUST Certified
Security and compliance are foundational to Agadia’s platform and operations.
Regulatory Alignment
Support evolving CMS, state, audit, and reporting requirements.
Continuous Enhancements
Ongoing solution improvements help clients respond to industry and regulatory change.
Agadia is more than software. We are an extension of your team.
Dedicated Account Management
Clients receive ongoing support through account management, operational consultation, and strategic reviews.
Integrated Support
Technical support, issue tracking, and troubleshooting help teams keep operations moving.
Training & Enablement
Implementation, refresher training, and learning management resources support adoption and long-term success.
See why leading health plans and PBMs choose Agadia.
Let’s discuss how Agadia can help your organization streamline utilization management, improve compliance, and deliver better outcomes.
