On Roadmap
This feature is on our roadmap.
Core Components of Our Notifications:
1. Drug Label Information:
- In-depth Analysis: Our platform continuously monitors and assimilates drug label information. This means we stay updated on approved dosages, recommended usage, potential side effects, and more.
- Integration into Denial Prediction: By ensuring that all prescriptions align with the latest drug label information, we significantly reduce the risk of denial due to non-compliance with drug guidelines.
2. Formulary Data Integration:
- Real-time Updates: We maintain up-to-date formulary data, ensuring our system knows which drugs are approved by specific PBMs/payers at all times.
- Informed Alerts: If a prescribed drug isn’t on an approved list or if there’s a more suitable alternative, our notifications will highlight this to reduce the chances of a denial.
3. Clinical Decision Criteria:
- Sourcing and Validation: Our platform sources clinical decision criteria directly from PBMs/payers. This data undergoes rigorous validation to ensure accuracy.
- Cross-referencing Submissions: Each prior authorization submission is cross-referenced with these criteria. Any discrepancies or potential issues are immediately flagged, allowing healthcare providers to adjust their submissions proactively.
4. Historical Prior Authorization Data:
- Vast Historical Database: We’ve accumulated an extensive database from past prior authorization submissions. This rich history offers a goldmine of insights.
- Pattern Recognition: Leveraging advanced algorithms, our platform identifies patterns and commonalities in past denials. By comparing new submissions with this historical data, our system can predict potential denial points with remarkable accuracy.