How Do You Use It?
Challenge:
Access teams were sitting on mountains of claims and formulary data—but couldn’t tap into it quickly. Field reps needed answers in real time:
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“What step edits are common in this region?”
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“Which plans cover our brand without PA?”
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“Where are we losing patients post-denial?”
Traditional dashboards were slow, clunky, and required manual digging. Excel wasn’t cutting it. Tableau couldn’t keep up with nuance. The team didn’t need another visualization tool. They needed an interface that spoke their language.
The Opportunity:
By building a natural language processing (NLP) interface over structured claims and formulary datasets, we gave business users the power to surface high-value insights using plain language queries—no SQL, no filters, no dashboards.
Think: “Alexa, but for access data.”
What We Did:
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Built a lightweight NLP layer over existing claims and coverage data using a custom-trained language model fine-tuned on healthcare access terminology.
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Integrated the interface into a web-based tool, enabling users to ask real questions like:
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“What’s the PA denial rate for GLP-1s in Texas commercial plans?”
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“Which PBMs are most likely to require step edits for our class?”
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Applied semantic parsing and intent mapping to route queries to the appropriate data logic, ensuring accuracy across benefit types, codes, and NDCs.
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Embedded usage analytics and autocomplete features to improve query speed and reduce friction.
Key Enablers:
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Pre-processed claims + formulary join mapped to therapeutic class, NDC, payer, and geography
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Custom intent classifier trained on 1,200+ access-related phrases
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Lightweight deployment using Python (FastAPI) and React front-end
Bottom Line:
You don’t need a massive AI platform to make access data usable. A simple NLP interface over structured claims and coverage datasets can unlock powerful, real-time insights for non-technical teams—and transform how field, access, and brand leaders make decisions.
Curious what this would look like for your data?
Let’s show you a working demo. No slide decks. Just results.
