Most of the time, when a person goes to a doctor, the various procedures, lab tests and treatments received go through the insurance company without a hitch. But others – particularly those that are more expensive – require prior authorization, a process that can be highly cumbersome and time-consuming, especially for providers and their staff.

Into this morass steps Itiliti Health, an Eden Prairie, Minnesota-based startup that aims to improve the efficiency and experience of prior authorizations – and in particular helping providers figure out when they are needed – using digital technology. The company was a winner of the MedCity INVEST Digital Health conference’s Pitch Perfect contest, in the category of Tech to Improve Payer/Provider Efficiency.

“To participate along with a number of very strong, leading companies in the industry is a really exciting opportunity, and we’re really pleased and honored to be selected as the winner,” CEO Michael Lunzer said in a phone interview.

Itiliti has two products: PA Checkpoint and PA Complete, the latter of which it plans to launch in the first quarter of next year. PA Checkpoint stores medical policies in a database and answers definitively if a prior authorization is needed or not, while PA Complete uses artificial intelligence and natural language processing to compare medical policies with a member’s medical record to determine on a line-by-line item basis whether a patient meets the criteria for prior authorization.

Lunzer, who co-founded Itiliti with COO Kurt Hulander, got the idea for the company when he took part in the entrepreneur-in-residence program at Blue Cross Blue Shield of Minnesota in 2018 and 2019. While looking for problems that affected the healthcare industry in a negative way, he found that prior authorization was one of them. Prior authorizations have traditionally been addressed inefficiently through fax transmission, to which payers have responded with provider portals that improve the transport of information, but not its processing. Information is presented in documents that are hard to read and often leave providers calling payers on the phone or submitting prior authorization when they can’t get a clear determination.

“Without our product, they typically have to look through PDF documents and spreadsheets on the health plan’s website, and those can be rather cumbersome and difficult to navigate,” Lunzer said in a phone interview.

Lunzer added that a large regional insurance provider has implemented PA Checkpoint and has been using it since May of last year.

Photo: Piotrekswat, Getty Images

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