The Pharmacy Benefit Analytics Platform is a secure, cloud-hosted solution designed to modernize legacy PBM systems by automating claim processing, enhancing data transparency, and enabling real-time analytics.
It empowers payors, TPAs, and pharmacy networks to reduce billing errors, ensure compliance, and make data-driven decisions — all from a unified, HIPAA-compliant environment.
The solution is built for chronic care management along with medical billing to maximize medical reimbursement. It aims to optimize the financial performance of a healthcare organization by ensuring accurate and timely billing, maximizing reimbursements, reducing claim denials, improving overall revenue, and maintaining high standards of patient care.
This project delivers an integrated AI and analytics platform for the Foundation for Sickle Cell Disease Research (FSCDR). It connects ECW (eClinicalWorks) EHR data with advanced AI-based predictive models to identify high-risk patients, automate follow-ups, and streamline state grant reporting (CMO99, CMOAE Tasks 5–13).
The goal is to transform static EHR data into actionable insights — improving research visibility, compliance, and patient outcomes while cutting down manual reporting workloads. The solution supports predictive ER-risk modeling, AI-based outreach automation, and Power BI-driven compliance dashboards across FSCDR’s Centers of Excellence.
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