Itiliti Health

Itiliti Health provides prior authorization technology sold to payers, built around communicating payer requirements clearly so that providers know what is needed before they submit. The company positions this as a better way to prior-authorize rather than as a faster way to process the same requests.

Making requirements explicit attacks the problem at a different point from automation, and arguably the right one. A large share of prior authorization delay comes from requests submitted without the documentation the payer requires, which are then returned, resupplied and resubmitted. Each round trip costs days. If the provider can see up front exactly what this payer needs for this procedure, the first submission is complete and there is nothing to send back.

Selling to payers rather than providers is the practical route to that, since the payer holds the rules and is the party able to publish them in a usable form. It is also the party that carries the cost of processing incomplete submissions.

The approach is less visible than automation but addresses the same waiting time from the other end. Faster review of an incomplete request still ends in a request for more information, so completeness at submission is what actually shortens the cycle.