Healthcare IT Software

What Healthcare IT Software does

HealthcareIT Software Inc., operating as HealthcareIT, is a privately held U.S. software and advisory company founded in 2014 and based in Orlando, Florida, that builds prior authorization workflow technology for health plans, pharmacy benefit managers (PBMs), third-party administrators (TPAs), specialty pharmacy and hub services, and Medicaid managed care organizations. The company's core product is a configurable Prior Authorization System composed of nine integrated modules that manage the full authorization lifecycle: request intake, data validation, criteria match, missing information and outreach, clinical review, determination, notice generation, appeal and reconsideration, and reporting and audit. The platform supports multi-channel intake (provider portals, APIs, files, fax/PDF), configurable clinical criteria and drug/class rules, a structured reviewer workbench for pharmacists, nurses, and medical directors, templated communications, and end-to-end audit trails.

The business operates a platform-plus-services model. Recurring software licensing and implementation services on the PA System generate the primary revenue stream under a quote-based pricing model, while six advisory service lines (PA Workflow Assessment, Drug and Pharmacy Benefit PA Strategy, Utilization Management Workflow Design, CMS / ePA Readiness Planning, Appeals and Audit-Ready Workflows, and a PBM Transparency and Analytics Roadmap) drive bottom-of-funnel engagement and implementation work. Go-to-market is direct enterprise field sales targeting payer and PBM buyers, with website CTAs focused on assessment scheduling and system walkthroughs, and the company has publicly staged a three-phase roadmap moving from current advisory work into configurable workflow tooling and eventually human-supervised, audit-ready automation. The company is small (1-10 employees), has not disclosed any outside funding, and is founder/management-owned.

Name

Healthcare IT Software

Legal name

HealthcareIT Software Inc.

Website

https://healthcareit.com

Company type

Private

Founded year

2014

Operating status

Operating

Headcount range

1–10 employees

Short description

HealthcareIT Software builds a configurable prior authorization workflow platform with nine integrated modules for health plans, PBMs, and TPAs, complemented by advisory services covering assessment, strategy, utilization management design, CMS/ePA readiness, appeals, and PBM analytics.

Ownership category

akta.pro rank

Product category

Prior Authorization Workflow Software

NAICS

Computer Systems Design and Related Services (54151), Custom Computer Programming Services (541511)

SIC

Services-Prepackaged Software (7372), Services-Computer Programming, Data Processing, Etc. (7370)

akta.pro primary industry

Prior Authorization (ePA), Utilization Management & Coverage Verification (HLACAKAE)

akta.pro secondary industries

Prior Authorization & Utilization Management (HLACACAC), PBM Technology Platforms (ePA/eRx/Real-Time Benefit Tools) (HLAEAKAL), Pharmacy Benefit Management (PBM) & Formulary Management IT (HLACAKAD), Pharmacy Interoperability, Standards & Integration (FHIR/NCPDP) (HLACAKAO)

Keywords

• Prior authorization software
• Pharmacy benefit management
• Utilization management
• Healthcare workflow automation
• Payer software platform

Headquarters

HQ city

Orlando

HQ country

United States

HQ region

North America

Markets served

GTM type

B2B

Offering type

Software

Cost components

Personnel, Technology or R&D, Marketing or Sales, Operations

Revenue model

1. Software Platform: Prior authorization workflow system sold as a configurable platform to payer, PBM, and TPA organizations. Revenue generated through software licensing and implementation services.

Go-to-market motion1 record

Distribution channels1 record

Marketing channels1 record

Core offering

HealthcareIT Software sells a configurable Prior Authorization (PA) System — a single platform with nine integrated modules (Request Intake, Data Validation, Criteria Match, Missing Info/Outreach, Clinical Review, Determination, Notice Generation, Appeal/Reconsideration, Reporting & Audit) — that helps health plans, PBMs, and TPAs manage the full authorization lifecycle from intake through determination, communications, appeals, and audit. Alongside the platform, it delivers assessment, strategy, and workflow design services covering workflow modernization, pharmacy benefit PA strategy, utilization management design, CMS/ePA readiness, audit-ready workflows, and PBM analytics roadmaps.

Product overview

Healthcare IT Software offers a platform-plus-services model centered on its Prior Authorization (PA) System — a configurable workflow platform with 9 integrated modules that manage the complete authorization lifecycle from intake through determination, communications, appeals, and audit. The platform is designed for health plans, PBMs, and TPAs and is built on real pharmacy benefit management experience since 2014. Alongside the core PA System, the company provides six advisory and implementation services: Prior Authorization Workflow Assessment, Drug & Pharmacy Benefit PA Strategy, Utilization Management Workflow Design, CMS/ePA Readiness Planning, Appeals & Audit-Ready Workflows, and PBM Transparency & Analytics Roadmap.

Differentiator

Problem solved

Functional benefit

Products and services

• Prior Authorization System (PA System)

Segments6 records

Ideal customer profiles5 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature7 records

Scale indicators3 records

Recent moves6 records

Expansion highlights5 records

Broad incumbents

• Change Healthcare (Optum): Major healthcare technology incumbent (now part of Optum) offering prior authorization, claims, and interoperability solutions across payers, providers, and PBMs. Larger portfolio player with overlapping PA capabilities.
• Experian Health: Provides prior authorization automation and other patient access solutions to health systems and payers. Broad incumbent with an overlapping PA workflow offering as part of a wider healthcare data portfolio.

Direct peers

• Availity: Healthcare information network offering prior authorization, eligibility, and clinical exchange workflows to health plans and providers. Closely comparable as a multi-payer PA workflow platform with health plans as primary buyers.
• Rhyme (PriorAuthNow): Prior authorization automation platform serving payers and providers with end-to-end PA workflow. Direct competitor to HealthcareIT's configurable PA system, particularly for medical and pharmacy benefit use cases.
• Surescripts: Operates one of the largest ePA networks linking prescribers, pharmacies, payers, and PBMs. Directly comparable as an ePA and pharmacy benefit technology platform targeting the same payer and PBM buyer base.
• Myndshft: Prior authorization automation vendor using real-time clinical data exchange to streamline PA for payers and providers. Comparable as a focused PA workflow software vendor competing in the same buyer segment.
• Inferscience: Provides prior authorization decision-support and clinical criteria tools integrated with EHR workflows. Comparable as a smaller PA-focused software vendor serving similar payer and provider customers.
• CoverMyMeds: The leading electronic prior authorization platform connecting providers, pharmacies, payers, and PBMs. Direct competitor to HealthcareIT's PA workflow system for pharmacy benefit and drug authorization use cases.

Emerging players

• AKASA: AI-driven healthcare revenue cycle and authorization automation vendor serving health systems and payers. Adjacent competitor addressing prior authorization within a broader automation platform.
• Olive AI (Commure): Healthcare automation platform (merged into Commure) with prior authorization as a flagship use case. Comparable emerging player automating PA and adjacent revenue cycle workflows for providers and payers.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights6 records

Customer concentration

Revenue estimate

Valuation estimate

Number of profiles

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Healthcare IT Software