Category
Prior authorization & UM
Prior auth and utilization management software for specialty providers, health plans, and PBMs. Fax portals are not a strategy.
This station covers prior authorization automation and utilization management platforms. Provider-side care-readiness tools and payer/PBM UM suites sit here together because buyers compare them when insurance friction is the problem.
Score outcomes on turnaround, clear-to-treat time, avoidable days, and audit readiness — not portal screenshots.
Reviews in this category
Anterior makes clinical AI for health plans that reviews prior authorization requests and other clinical work against plan guidelines, approving clear cases in minutes and preparing the rest for nurse review.
Latent makes AI software for health system pharmacies that reads the patient chart and payer rules to complete eligibility reviews, prior authorizations, and appeals for specialty medications.
Xsolis is an AI utilization-management platform for providers and payers. It supports status determination and collaboration so UM teams can reduce manual review friction.
Infinitus builds AI agents that automate healthcare phone and digital work for benefit verification, prior authorization follow-up, appeals, and related access tasks.
Humata Health makes AI software that gathers the clinical records a payer needs, matches them to payer policy, and submits and tracks prior authorization requests for health systems and payers.
Agadia builds PAHub and related utilization-management software for health plans and PBMs. It automates medical and pharmacy prior authorization and adjacent compliance workflows.
Careviso makes seeQer, a patient-access platform that automates prior authorizations, benefit checks, and cost estimates for labs, specialty providers, and ordering networks.
Silna Health is a care-readiness platform for specialty providers. It handles prior authorization, benefits checks, and insurance monitoring so patients are clear to receive care.
Itiliti Health automates prior authorization by exposing payer medical policies and driving electronic PA workflows for plans and providers.
Banjo Health provides AI-assisted prior authorization, appeals, and clinical criteria automation software for health plans and PBMs.
SamaCare is a medical-benefit prior authorization platform for specialty practices. It supports submission, tracking, and insights from real-world authorization data.
Develop Health is an EHR-integrated benefits verification and prior authorization platform focused on medication access, including drafting, status, and appeals for pharmacy-benefit pathways.
Hindsait makes clinical AI that turns unstructured medical records into structured evidence for payer teams reviewing prior authorization and utilization management requests.
Valer automates prior authorization and referral management for provider organizations across many payer portals, with status checking and EHR synchronization.
Rhyme (formerly PriorAuthNow) is a provider-payer prior authorization network that aims for touchless submission and status, with observation analytics and gold-carding tools.
Linear Health makes AI software that does prior authorization, referral coordination, and related desk work for specialty practices inside the EMR, payer portals, and documents their staff use.