JSON twin: https://www.healthaidb.com/software/itiliti-health.json
Itiliti Health
https://itilitihealth.com/products/
Cloud-based prior authorization automation and medical policy platform that lets providers and payers determine PA requirements in real time and reduces administrative burden.
Itiliti Health offers PA Checkpoint and related payer-focused SaaS solutions that digitize medical policies, automate prior authorization routing/decisions, provide auditable reporting, and integrate via APIs to improve call center efficiency and reduce unnecessary PA submissions for health plans and provider networks.
yes
2019
P0843
2025-09-07
commercial proprietary
Contact vendor for pricing; enterprise SaaS with implementation services (no public list prices; demo/trial by request).
enterprise_quote
2019
Cloud-hosted (AWS referenced); integrates via APIs/EDI with existing payer/provider systems; no heavy on-prem requirements for typical deployments
product
1.0
{
"company_name": "Itiliti Health",
"company_url": "https://itilitihealth.com",
"company_offices": [
"United States"
],
"company_founding": "2019",
"product_url": "https://itilitihealth.com/products/",
"categories": [
"administrative",
"prior authorization",
"utilization management",
"medical policy management",
"interoperability",
"clinical decision support",
"payer-facing",
"provider-facing"
],
"market_segment": [
"enterprise",
"payers",
"providers"
],
"links": [
"https://itilitihealth.com",
"https://itilitihealth.com/products/",
"https://itilitihealth.com/solutions/",
"https://itilitihealth.com/partners/",
"https://itilitihealth.com/blog/itiliti-health-raises-2m-to-improve-prior-authorization/",
"https://elion.health/products/itiliti-health",
"https://www.crunchbase.com/organization/itiliti-health",
"https://itilitihealth.com/blog/itiliti-health-launches-integrated-solution-for-prior-authorization-automation/",
"https://itilitihealth.com/news/",
"https://itilitihealth.com/contact/"
],
"summary": "Cloud-based prior authorization automation and medical policy platform that lets providers and payers determine PA requirements in real time and reduces administrative burden.",
"description": "Itiliti Health offers PA Checkpoint and related payer-focused SaaS solutions that digitize medical policies, automate prior authorization routing/decisions, provide auditable reporting, and integrate via APIs to improve call center efficiency and reduce unnecessary PA submissions for health plans and provider networks.",
"target_users": [
"payers (health plans)",
"provider staff (clinicians, office administrators)",
"utilization management teams",
"call center agents",
"IT/integration teams",
"compliance/operations leaders"
],
"specialties": [
"prior authorization",
"medical policy management",
"utilization management",
"care management",
"revenue cycle/administrative workflows"
],
"regions_available": [
"United States"
],
"languages_supported": [
"English"
],
"pricing_model": "enterprise_quote",
"pricing_details": "Contact vendor for pricing; enterprise SaaS with implementation services (no public list prices; demo/trial by request).",
"license": "commercial proprietary",
"deployment_model": [
"cloud SaaS",
"modular/plug-and-play (API-based)"
],
"os_platforms": [
"web (provider portal integration)"
],
"features": [
"Real-time determination whether a prior authorization (PA) is required (PA Checkpoint)",
"Searchable, structured medical policy database organized by CPT",
"Policy management (create, import, redline, comment, versioning)",
"PARDD/CRD and DTR interfaces for policy discovery and document exchange",
"APIs for coverage requirement discovery and workflow integration",
"PA routing rules to direct submissions to correct department/LOB",
"Automatic authorization rules (auto-approve when structured criteria met)",
"Clinical Decision Assistant with AI/ML search and evidence tagging",
"Audit trail and comprehensive reporting",
"Provider portal and payer website integration",
"Mass upload/import of policy requirements (spreadsheet/API)",
"Configurable role-based user management and access restrictions",
"Phased implementation capability (under 60 days typical)"
],
"optional_modules": [
"Policy Management",
"PA Routing",
"Automatic Authorization Rules",
"Clinical Decision Assistant",
"PA Complete / end-to-end PA automation (integrations with partners)"
],
"integrations": [
"Provider portals (seamless access via existing portals)",
"Health plan/payer systems (via APIs/EDI)",
"VirtualHealth (HELIOS integration / partnership)",
"Onyx (OnyxOS connector partnership)"
],
"data_standards": [
"FHIR Prior Authorization (PARDD / CRD)",
"PARDD Documents/Templates/Requirements (DTR)",
"EDI (standard EDI/claim/transaction interfaces)"
],
"api_available": "yes",
"system_requirements": "Cloud-hosted (AWS referenced); integrates via APIs/EDI with existing payer/provider systems; no heavy on-prem requirements for typical deployments",
"compliance": [
"HIPAA",
"SOC 2",
"HITRUST"
],
"certifications": [
"SOC 2",
"HITRUST"
],
"security_features": [
"Role-based access control (user management with roles)",
"Access restrictions and logging / audit trails",
"Secure API interfaces",
"Encryption in transit and at rest (site states secure deployment and security measures)"
],
"privacy_features": [
"Payer-controlled policies and data (payer retains control of policy data)",
"Privacy practices and security measures described in company Privacy Policy"
],
"data_residency": "",
"customers": [
"Major Blues Plan",
"Large Regional Health Plan",
"Health Plan"
],
"user_reviews": [],
"ratings": [],
"support_channels": [],
"training_options": [],
"release_year": "2019",
"integration_partners": [
"VirtualHealth",
"ZS",
"Epic",
"VirtualHealth HELIOS"
],
"id": "P0843",
"slug": "itiliti-health",
"type": "product",
"version": "1.0",
"last_updated": "2025-09-07",
"links_json": {
"self": "https://www.healthaidb.com/software/itiliti-health.json"
}
}