Agadia is a leading healthcare management technology company addressing the evolving needs of the managed care market with a suite of utilization management solutions in electronic prior authorization, MTM, part d star ratings & adherence, and formulary benefit design. Used by the nation’s largest health plans and PBMs, Agadia’s advanced technology solutions help drive operational efficiency, appropriate utilization, compliance, and profitability. For more information, visit www.agadia.com.

Patient access departments are charged with accuracy from the start. 

Challenges—claims denials, returned mail, regulatory burdens and low patient satisfaction—are barriers they face. Solutions that empower registrars and staff with intuitive, consistent workflows and that prepare patients for their financial obligations have been elusive—until now.

True Access™ clearly and accurately fills the gaps in preservice coverage verification and estimation of patients’ financial obligations. Staff gain consistent workflows and patients receive precisely tailored payment options everywhere. True Access includes additional patient access tools for staff to support eligibility and address verification, medical necessity and prior authorization processes.

With True Access from RevSpring, you receive proven solutions that support four critical areas: 

(1) Coverage Determination and Verification,

(2) Claim Denial Prevention,

(3) Patient Financial Readiness and Increased

Collections, and

(4) Tools, Workflows and Reporting for Staff.

Coverage Determination & Verification

Fast, simple and accurate resolution of all patient accounts prior to, or at the point of, service—no matter whether or not patients are insured, uninsured, underinsured and/or qualify for financial assistance. Includes Eligibility, Coverage Verification and Determination, and Medicaid Coverage Discovery.

Claim Denial Prevention

True Access reduces time spent rebilling claims and reduces days in AR by submitting claims correctly from the start. Includes Prior Authorization and Precertification, Medical Necessity and Coordination of Benefits.

Patient Financial Readiness & Increased Collections

Prepare patients for their financial responsibility and empower them to pay precisely what they can, when they can, from anywhere. Accurate estimates, seamlessly 

integrated with RevSpring’s PersonaPay portal, enable patients to manage their balances with confidence. Our hassle-free billing adjustment solution also allows 

providers to confidently request payments in advance.

Tools, Workflows & Reporting for Staff

True Access empowers staff with intuitive workflows and a modern user interface to manage registration quickly and efficiently. Intuitive staff views based on work queues and guided workflows drive consistency and accuracy, saving time for patients and staff. Our tools also allow you to monitor staff performance.

RevSpring leads the market in healthcare engagement and payment solutions that inspire patients to participate in and pay for their healthcare. We’ve built Engage IQ™, the industry’s only connected patient engagement suite designed to coordinate patient interactions from pre-care to post-care to payment. RevSpring’s intelligent, holistic platform puts patient understanding at the center of one connected personal experience, allowing providers to fully optimize patient satisfaction, data accuracy, staff efficiency and financial outcomes. The company’s OmniChannel communications and payment solutions are backed by intelligence, analytics, contextual messaging and user experience best practices. RevSpring was rated #1 for Most New Capabilities in Patient Engagement by KLAS in 2023 and Best in KLAS in Patient Communications in 2024.

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.

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.