AI-Driven Automation
2
Human Touches
in a 12-stage fully automated PA pipeline
NexusLedge automates the entire PA lifecycle from document intake to determination letters. Only clinical review and final determination require human judgment.
End-to-End Pipeline
12 stages. 10 automated. 2 human.
Document Intake
Inbound documents from fax, email, and prescriber portal captured automatically.
AutomatedAI Classification & Routing
Vision AI classifies document type and routes to appropriate workflow with confidence scoring.
AutomatedPA Request Creation
Structured PA request created from extracted clinical data, matched to member and prescriber.
AutomatedProtocol Matching
Request matched to clinical protocol based on drug, diagnosis, and plan configuration.
AutomatedClinical AI Assessment
3-tier AI assessment: per-attachment, per-question, and holistic clinical analysis.
AutomatedTask Population
Clinical review tasks auto-populated from protocol requirements and AI assessment results.
AutomatedClinician Review
Licensed pharmacist reviews AI assessment, clinical documents, and populated tasks.
ePrescribing Integration
Architected for NCPDP SCRIPT electronic prescribing with automated transaction processing.
AutomatedSLA Monitoring
Continuous SLA tracking with escalation alerts and regulatory compliance timers.
AutomatedDetermination
Clinical determination made by authorized pharmacist with full audit trail.
Letter Generation
Determination letters auto-generated with clinical rationale and appeal instructions.
AutomatedAudit Trail
Complete audit trail of every action, AI inference, and clinical decision.
AutomatedThe Human Touch
Where Humans Matter Most
Clinician Review
AI prepares everything — document analysis, clinical scoring, task population — but the licensed pharmacist makes the clinical judgment call. They review AI assessments with full context, validate findings against clinical documents, and apply the professional expertise that no algorithm can replace.
Why human: Clinical judgment requires professional licensure, contextual reasoning, and accountability that must rest with a qualified clinician.
Determination
The final approval, denial, or pend decision is made by an authorized pharmacist with a complete audit trail. Every piece of supporting evidence, every AI inference, and every clinical task result is visible at the moment of determination.
Why human: Regulatory requirement. Clinical accountability. A determination is a medical decision that carries legal weight — it must come from a licensed professional.
10
Automated Stages
2
Human Touches
12
Pipeline Stages
3
AI Assessment Tiers
"We automated everything that doesn't require clinical judgment, so pharmacists can focus entirely on the decisions that matter. The pipeline handles the paperwork; clinicians handle the medicine."
Explore the Platform
How AI-driven automation connects to the platform
See the automation pipeline in action
Request a demo to see how 12 stages work end-to-end with your clinical protocols.
See the Platform