Claims & Identifiers
NDC, NPI, GPI validation with evidence.
340B & Formulary
Date-aware rules and indicator analysis.
Payment Integrity
Connect claim evidence to financial controls.
NDC, NPI & GPI Validation
Identify missing or inconsistent drug and provider identifiers and surface the evidence needed to resolve them.
SCC / 340B Investigation
Analyze applicable submission clarification indicators and related claim evidence without treating uncertain cases as facts.
Ingredient Pricing
Compare ingredient pricing against approved reference data, including WAC, AWP and effective dates.
Formulary Reconciliation
Evaluate formulary status, tiers and restrictions as they applied to the relevant dispensing date.
Rx → Dispensing → Claim
Match a claim to the exact prescription and dispensing event rather than relying on loose temporal or text similarity.
Financial Investigation
Connect claim evidence to payment and exception workflows to strengthen controls and reduce manual research.
Clinical Workflow Intelligence
Support existing prior authorization and clinical workflow concepts with evidence-backed assistance.
Private AI Operating Model
Governed pipeline from ingest through human approval — private models, full auditability, human-in-the-loop.