Prior Authorization
From intake to determination.
One platform.
Full PA lifecycle with AI-powered clinical assessment at every step. Configurable per PBM hierarchy. SLA monitoring with breach alerts.
Lifecycle
Every stage. Fully managed.
Intake
Fax, email, and portal submission with ePa-ready architecture. AI-powered document triage and auto-routing.
Questionnaire
Protocol-driven clinical questionnaires. Prescriber-facing portal with OCR pre-population.
Clinical Review
3-tier AI assessment assists clinicians. Clinical AI chat for contextual guidance.
Decision
Approve, deny, or request additional info. Determination letters with managed encryption.
Appeal
Configurable appeal windows. Full appeal lifecycle with audit trail.
Acknowledgment
Response transmission and status notifications. Complete audit history.
12
Pipeline Stages
10
Automated Stages
2
Human Touches
100%
Audit-Ready
"The difference between attestation and validation is simple: one records what the prescriber said, the other verifies whether it's true. We built NexusLedge for verification — every clinical criterion checked against actual patient data before the pharmacist reviews the case."
Explore the Platform
Prior Authorization across the platform
AI Capabilities
Clinical AI intelligence
The 3-tier AI assessment powering every PA review — document scan, clinical question evaluation, holistic judgment.
Validated Compliance
Governance and audit trail
Every PA determination is logged, auditable, and defensible. Compliance verified, not attested.
Operational Intelligence
PA performance visibility
Turnaround times, SLA compliance, approval rates — every PA metric visible without an engineering ticket.
See the full PA lifecycle in action
Request a demo to see how the 12-stage pipeline handles your clinical protocols.
See the Platform