The AI Operating System for
PBM Clinical Operations
NexusLedge embeds AI into every clinical workflow — from document intake to clinical assessment to determination — so your team makes faster, better decisions with full auditability.
8
AI capabilities in production
7-level
PBM hierarchy configuration
NCPDP
SCRIPT v2023011 compliant
HIPAA
Compliant by architecture
Platform
One platform. Every clinical workflow.
Purpose-built for PBM operations. Not a network middleman. Not a portal. A complete operating system.
Prior Authorization
Full lifecycle from intake to determination letter. AI-powered questionnaire assessment, SLA monitoring, and configurable appeal workflows.
🧠AI Clinical Intelligence
3-tier assessment pipeline, document intelligence triage, clinical AI chat, and configurable prompt registry. All auditable.
📡ePrescribing
Real-time electronic PA via Surescripts. 12 NCPDP SCRIPT transaction types with full XML serialization.
💊Formulary Management
Medispan 500K+ drug catalog, hierarchical formulary association, NDC-to-GPI resolution, tier management.
📈Medication Adherence
PQA-defined PDC calculation engine, Star Ratings monitoring, intervention documentation, prescriber reporting.
⚙️Platform Configuration
7-level hierarchy (system to plan), per-tenant isolation, configurable SLA windows, file limits, and AI prompts.
Why NexusLedge
Independent. AI-native. Hierarchy-aware.
7
Configuration Levels
System to Plan. Lowest-level wins with locked value override. No competitor has this granularity.
0
Conflicts of Interest
We serve PBMs. We don't compete with them. No parent company processing claims against you.
100%
Cloud-Native
Serverless on AWS. No on-prem installation. Go live in weeks, not quarters.
Solutions
Built for every stakeholder in the PA ecosystem
For PBMs
Your PBM is unique. Your platform should be too. Hierarchy-aware configuration, end-to-end PA processing, and AI your clinicians control.
Learn more →For Prescribers
One portal. Every PBM. Submit, track, and manage prior authorizations from your browser. No fax, no software install.
Learn more →For Health Plans
Require your PBMs to operate on a modern, auditable platform. Every AI decision logged, explainable, and configurable.
Learn more →Ready to modernize your PBM operations?
See how NexusLedge embeds AI into every clinical workflow.
See the Platform