Prior authorization & UM · Payer rules & ePA automation
Itiliti Health
Itiliti Health automates prior authorization by exposing payer medical policies and driving electronic PA workflows for plans and providers. It is PA interoperability software, not a core claims system.
Strong fit
- Health plans getting ready for electronic prior authorization rules that need to show providers their payer rules clearly
- Utilization management leaders who want automation based on published medical policies, not only more nurse reviewers
- Buyers comparing mid-sized prior authorization exchange platforms ahead of CMS-0057 deadlines
Weak fit
- Solo clinics that only need a tool to fill out prior authorization forms instead of faxing
- Plans locked into one utilization management system with no budget for another tool
- Buyers that need imaging AI, not authorization tools
Bottom line
Itiliti Health is worth considering for health plans and providers that want to publish payer rules clearly and automate electronic prior authorization. It suits teams ready for a policy and interoperability project. Plans that want mature AI prediction or a full suite may prefer Xsolis or Agadia.
Score breakdown
Weights: Outcomes 35% · Product 30% · Implementation 20% · Pricing clarity 15%.
Itiliti Health is a prior authorization company in Eden Prairie, Minnesota, founded by Michael Lunzer and led by CEO Kevin Aniskovich. The team is small and early in its growth compared with Agadia or Xsolis.
Plans and providers use it to share payer medical policies clearly and automate electronic prior authorization, so they rely less on portals and faxes. It is software for exchanging prior authorizations, not a core claims system or imaging AI.
Setup is a project to put utilization management policies into the system and connect plans with providers. Pricing follows the model for large business software.
Among prior authorization tools we review, Itiliti scores close to Silna for focused automation. It scores below Xsolis, whose AI for predicting utilization is more mature.
Agadia suits plans and pharmacy benefit managers that need the mature PAHub suite. Banjo Health suits plans that want AI tools for writing criteria, and Xsolis suits buyers whose main purchase is AI that predicts utilization.
Competitor landscape
| Vendor | Overall | Ease of implementation |
|---|---|---|
| Anterior | 8.1 | 8.1 |
| Xsolis | 7.8 | 7.3 |
| Infinitus | 7.7 | 7.4 |
| Humata Health | 7.7 | 7.4 |
| Agadia | 7.6 | 7.2 |
| Careviso | 7.6 | 7.3 |
| Silna Health | 7.3 | 7.1 |
| Itiliti Health | 7.3 | 7.1 |
| Banjo Health | 7.2 | 7.0 |
| Hindsait | 7.0 | 6.7 |
| Rhyme | 6.5 | 6.3 |
Pricing
| Item | Detail |
|---|---|
| Model | Subscription software for automating prior authorization, quoted for plans and partners. |
| What usually drives cost | How many authorizations you process, lines of business, how many policies are covered, and how much connection work is needed. |
| What to ask before you buy | The yearly fee at your authorization volume, including policy setup and training. |
| Published pricing | Itiliti does not publish a price list. |
Prerequisites for purchase
| Need | Why it matters |
|---|---|
| What you need to get Itiliti Health to function | |
| A named owner for utilization management or prior authorization | Policy projects stall without owners. |
| Medical policies chosen for automation | Vague rules produce bad decisions. |
| Starting prior authorization turnaround times | You cannot show improvement without a starting point. |
| A clear way to connect payers and providers | Electronic prior authorization fails without connections. |
| A written appeals process | Automation still needs a person who can override it. |
| What will maximize your value | |
| Start with one line of business | Launching everything on day one multiplies the noise. |
| Measure the share handled with no staff touch at 90 days | This shows the automation works. |
| Retire portal bots that do the same job | Duplicate authorization queues confuse staff. |
| Deal-breakers | |
| You only need a fax form filler | |
| You cannot share policies | |
| No one owns utilization management | |
Value creation time frame
| # | Stage | Typical range |
|---|---|---|
| 1 | Map policies and security | 4-8 weeks |
| 2 | Test one line of business | 6-12 weeks |
| 3 | Expand electronic prior authorization | 4-8 weeks |
Leadership
Methodology
| Weight | Factor | What it measures |
|---|---|---|
| 35% | Customer outcomes | Whether buyers get measurable operational or clinical-workflow results after go-live |
| 30% | Product | Capability depth, reliability, and fit for the job the category buys |
| 20% | Implementation | How hard it is to stand up, integrate, train, and stabilize |
| 15% | Pricing clarity | Whether a buyer can model total cost without a mystery quote |
| Label | Meaning |
|---|---|
| Highly recommend | Strong outcomes and product with manageable caveats |
| Recommend | Solid fit for the right buyer; know the tradeoffs |
| Conditional | Only with a specific use case or heavy caveats |
| Not recommended | Avoid for most buyers in this category |
Read our full methodology for how we weight scores and assign recommend labels.