Black Book Research has released its 2025 rankings for top Utilization Management (UM) and Prior Authorization (PA) vendors, highlighting a significant shift towards AI-driven solutions among healthcare payers.

These rankings are based on feedback from 1,632 verified payer executives, IT directors, and clinical operations leaders surveyed from the third quarter of 2024 to the second quarter of 2025.

The report underscores a major industry shift towards interoperable, AI-driven solutions aimed at enhancing efficiency, compliance, and member satisfaction in healthcare plans.

Doug Brown, President of Black Book Research, noted that health plans are increasingly moving away from manual prior authorization methods in favor of scalable technologies that improve decision-making and process automation.

Key areas of focus for payer software solutions include accurate risk scoring, regulatory compliance, predictive analytics, automated coding, and interoperability, with respective priorities of 94%, 89%, 87%, 70%, and 66%.

Among the top vendors, Onyx is recognized for its FHIR-based interoperability solutions, while Apixio leverages natural language processing to validate medical necessity and automate chart reviews effectively.

Cotiviti is valued for its efficiency in concurrent authorizations and the alignment of clinical and financial data, enhancing the overall authorization process.

Availity stands out for its real-time automation capabilities that strengthen relationships between payers and providers, while Infinx is recognized for its predictive analytics that help prevent denials.

Inovalon enhances accuracy in risk scoring, and its analytics-driven platforms are distinguished for interoperability with payer systems.

Cohere Health is noted for its AI-driven workflows that reduce unnecessary prior authorizations and expedite patient care, showcasing the trend towards automation in healthcare.

The report evaluates vendors based on 18 key performance indicators, emphasizing the importance of automation, regulatory compliance, and member satisfaction.

Brown emphasizes that adopting risk adjustment and coding optimization software is crucial for payers to thrive in a competitive healthcare landscape.