Coming Soon
This product is in development and coming soon.
The Challenge
Healthcare providers often face challenges in determining the most suitable medication for patients due to plan constraints. This lack of clarity can lead to multiple, time-consuming prior authorization cycles, resulting in delayed treatment and increased operational costs.Our Solution: Clinical Qualification Endpoint
To address this, Develop Health offers a Clinical Qualification endpoint, an innovative solution designed to work alongside our Benefit Verification service. This endpoint takes patient coverage information, clinical data, and a list of drugs to output whether a patient is clinically eligible for each drug. The response includes a detailed tree structure for each drug, with annotations indicating eligibility based on clinical criteria.Example: Saxenda Eligibility Criteria
The service evaluates various criteria like age, behavioral modification trial duration, BMI criteria, and additional criteria like concomitant behavioral modification and diet. Each criterion branches further to determine the final eligibility, providing clear insights into initial and continuing therapy eligibility.Implementation Components
Our solution includes several key components:- Robust PA Policy Document Matching: Utilizes formulary data provider and patient coverage information to accurately find prior authorization policy documents.
- PA Policy Document Parsing: Extracts clinical decision criteria from documents, structuring them into a tree format for each drug.
- Eligibility Evaluation: Assesses patient’s eligibility based on clinical data against the structured criteria.
- Endpoint for Information Submission and Response: Facilitates the submission of necessary data and provides structured responses.
- User Interface for Visualization: Enables providers to visually review and understand the eligibility evaluation.