The Complete PBM Operations Platform
Clinician-Built. AI-Driven Automation. Validated Compliance. Three pillars powering every clinical workflow.
Platform Pillars
Clinician-Built. AI-Driven. Validated.
Every capability built on clinical expertise, intelligent automation, and validated compliance.
Clinician-Built
Clinical Pharmacy Expertise
Clinical pharmacists designed the platform — the workflows, the assessment logic, the governance model. Domain credibility, not another tech company guessing at healthcare.
⚡AI-Driven Automation
End-to-End Pipeline
10 automated stages, 2 human touches. 12-stage end-to-end PA pipeline.
⚙️Validated Compliance
Governance & Accountability
Every decision verified, auditable, and defensible. Compliance is validated against evidence, not attested on a form.
Feature Domains
Deep capability pages
Prior Authorization
Full lifecycle management: intake, questionnaire, clinical review, AI assessment, decision, appeal, and acknowledgment. SLA monitoring with breach alerts. Encrypted determination letters.
ePrescribing
Architected for real-time electronic PA via Surescripts and the NCPDP SCRIPT standard. ePa-ready architecture with built-in operations dashboard.
Formulary Management
Medispan 500K+ drug catalog integration. Hierarchical formulary association, NDC-to-GPI resolution, drug tier management, quantity limits, step therapy groups.
Medication Adherence
PQA-defined PDC calculation engine (PDC-DR, PDC-RASA, PDC-STA). Star Ratings monitoring, intervention documentation, prescriber adherence reporting.
Regulatory Agility
AI-accelerated platform evolution. Regulatory mandates and commercial plan changes become production-ready capabilities in days, with full compliance validation.
Operational Intelligence
Self-service analytics across clinical operations, AI performance, and organizational health. Every metric follows your organizational structure.
Architecture
Built different. On purpose.
Complete Tenant Isolation
Every PBM operates in its own isolated environment. No shared data, no cross-tenant access. HIPAA-compliant by architecture, not by policy.
No-Bottleneck PA Processing
PA processing runs without bottlenecks. Document intake, AI assessment, and routing happen concurrently so clinicians get cases faster.
Cloud-Native Infrastructure
Enterprise-grade cloud infrastructure with zero on-premises hardware. No servers to manage, no patches to apply. Go live in weeks, not quarters.
Validated Compliance
Every action, every AI recommendation, every clinician determination is logged and traceable. Compliance is verified, not just attested.
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See how NexusLedge embeds AI into every clinical workflow.
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