Business Details
20 Years
experience
Your Trusted Partner in Healthcare Technology Solutions
Agadia Systems has been at the forefront of healthcare innovation since 2006, dedicated to transforming utilization management through advanced automation and compliance solutions. Our team of industry veterans brings decades of combined experience in pharmacy benefits management, prior authorization technology, and healthcare IT to deliver scalable, efficient systems for health plans, PBMs, and TPAs. We pioneered the development of electronic prior authorization workflows as part of the NCPDP task group and continue to lead industry advancements through AI-powered platforms like PAHub. Our solutions have demonstrated measurable ROI for clients, including a 386% increase in PA volume with reduced staffing requirements and 199% first-year internal rate of return.We maintain strict compliance with HITRUST standards and Medicare Part D guidelines while continuously innovating to meet evolving regulatory requirements. Our commitment to client success is evidenced by long-term partnerships with industry leaders and implementation of over 30 customer solutions. We differentiate ourselves through proactive product development driven by CMS regulations and emerging technological trends, ensuring clients stay ahead in dynamic healthcare environments. Our leadership team combines deep technical expertise with clinical insights to deliver solutions that improve patient outcomes while optimizing operational efficiency.
Services
Electronic Prior Authorization
Medication Therapy Management
Formulary Benefit Design
Grievance Management
Clinical Workflow Automation
Compliance Surveillance
Data Analytics
Interoperability Solutions
AI-Driven Healthcare IT
Regulatory Compliance
Details
- Year established: 2006
Highlights and features
- We pioneered NCPDP electronic prior authorization workflow standards
- Our solutions have demonstrated 386% PA volume growth with reduced staffing
- HITRUST-certified platforms ensure strict regulatory compliance
- Leadership team combines 25+ years of healthcare IT and clinical expertise
- Proven 199% first-year ROI for health plan clients
Associations and certifications
- HITRUST
What people say
Fantastic partner
Instrumental in ensuring compliance
Phenomenal to work with
Terrific product
Improved productivity
Services
Electronic Prior Authorization
Our PAHub platform automates prior authorization workflows for pharmacy and medical benefits. This HITRUST-certified solution reduces administrative burdens through AI-powered decision engines and machine learning document processing. Health plans and PBMs use our system to achieve faster processing times, improved compliance, and significant cost savings while maintaining regulatory adherence.
Medication Therapy Management
We develop comprehensive medication therapy management solutions that optimize drug utilization and improve patient outcomes. Our systems integrate with existing workflows to identify medication-related issues, track adherence, and ensure appropriate therapy management across commercial, Medicare, and Medicaid populations while maintaining compliance with CMS requirements.
Formulary Benefit Design
Our FormularyHub solution provides dynamic formulary management capabilities for health plans and PBMs. The platform supports complex formulary design, tiered benefit structures, and regulatory compliance while enabling data-driven decisions to optimize medication coverage and cost-effectiveness across multiple lines of business.
Grievance Management
Our GrievancesHub solution automates healthcare grievance and appeal processes while ensuring regulatory compliance. The system tracks cases through resolution, maintains audit-ready documentation, and provides analytics to identify systemic issues. This helps organizations meet CMS timelines and improve member satisfaction through efficient complaint resolution.
Clinical Workflow Automation
We implement automation solutions that streamline clinical workflows across healthcare organizations. Our systems reduce manual processes through intelligent document extraction, auto-decision rules engines, and integrated reporting tools. These solutions improve operational efficiency while maintaining clinical accuracy and regulatory compliance for prior authorizations and other utilization management processes.
People
Sri Swarna
President & CEO
Sri Swarna leads Agadia Systems's strategic direction with 20+ years of healthcare IT experience. He pioneered electronic prior authorization standards as an NCPDP task group member and focuses on developing scalable solutions for healthcare organizations.
Scot Lovejoy
Chief Pharmacy Officer & CCO
Scot Lovejoy brings 40+ years of pharmacy and compliance expertise to Agadia Systems. A certified healthcare compliance professional, he oversees clinical operations and regulatory adherence while maintaining pharmacy industry leadership roles.
Bala Nagarathnam
Chief Technology Officer
Bala Nagarathnam directs Agadia Systems's technological innovation with 25+ years in healthcare IT. He leads infrastructure development and ensures operational stability while implementing cutting-edge solutions for client needs.
Ross Loomis
SVP of Sales
Ross Loomis drives business development with 17+ years in the PBM and health plan industry. His experience at Express Scripts and Centene informs client-focused sales strategies that build long-term partnerships.
Tim Capstick
SVP of Sales - PAHub Medical
Tim Capstick leads medical benefit management sales with 25+ years in healthcare technology. His expertise in prior authorization systems and interoperability solutions helps clients adopt effective technology platforms.
Questions
What is PAHub and how does it improve prior authorization?
PAHub is our HITRUST-certified platform that automates prior authorization workflows for pharmacy and medical benefits. It reduces processing times by 133% through AI-powered decision engines and machine learning document processing while maintaining regulatory compliance.
How does Agadia Systems handle regulatory compliance for healthcare clients?
We maintain HITRUST certification and ensure Medicare Part D compliance through continuous surveillance systems. Our platforms automatically update for new CMS regulations and industry requirements to keep clients audit-ready.
What healthcare sectors does Agadia Systems serve?
We support health plans, PBMs, TPAs, and healthcare organizations across commercial, Medicare, Medicaid, and exchange lines of business with scalable utilization management solutions.
Can Agadia Systems's solutions integrate with existing healthcare systems?
Our platforms feature interoperability solutions using FHIR/HL7 standards and integrate with EHR systems. The modular architecture allows seamless implementation with existing clinical and administrative workflows.
What ROI can clients expect from Agadia Systems's solutions?
Clients have achieved 199% first-year ROI, 386% increased PA volume with reduced staffing, and 133% faster processing speeds through our automated systems and operational efficiencies.
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