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Overview

Seamless Integration with Payor Systems

Real-time pharmacogenomic insights that fit directly into your claims, utilization management, and population health workflows.
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Overview
Payors operate in a data-intensive ecosystem where every system—from claims processing to care management—must communicate efficiently. PGxAI is designed to integrate seamlessly with your existing payor infrastructure, delivering AI-driven pharmacogenomic insights in real time. By embedding evidence-based PGx recommendations into your current workflows, you can make data-driven coverage decisions, reduce administrative overhead, and elevate the member experience.
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HL7/FHIR-Compatible: Ensures secure, standardized data exchange with claims and care management systems.
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InterSystems IRIS for Health: High-performance data platform enabling scalability across large member populations.
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HIPAA & SOC 2 Compliance: Safeguards member data while maintaining seamless interoperability.
Key Features
Serving every stakeholder in healthcare
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Automated Claims Alignment
PGxAI flags relevant CPT codes for genomic testing and consultations, reducing billing confusion and claim denials.
Streamlined coverage decisions thanks to real-time data linking genetic profiles with formulary rules.
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Real-Time Alerts & Decision Support
Embedded pharmacogenomic triggers within utilization management systems identify high-risk therapies, preventing costly adverse events.
Population health dashboards highlight members who could benefit most from PGx testing.
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Adaptive Utilization Management (UM)
Advanced AI models continuously refine coverage policies based on emerging PGx data.
Quickly respond to new genetic markers, drug approvals, or safety alerts without overhauling legacy systems.
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Centralized Data Repository
Consolidate member-specific PGx reports, claims history, and clinical outcomes under one secure, unified platform.
Facilitates collaboration between payor teams, network providers, and third-party administrators.
Implementation
PGxAI supports a broad spectrum of oncology treatments
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Assessment & Planning
Assessment & Planning
Evaluate current workflows, EHR compatibility, and clinical objectives to create a tailored integration roadmap.
Configuration & Pilot
Configuration & Pilot
Configure PGxAI interfaces (FHIR/HL7), install necessary modules, and conduct a small-scale pilot in one department or clinic.
Training & Onboarding
Training & Onboarding
Host interactive sessions and webinars to ensure clinicians, pharmacists, and IT staff understand how to interpret PGx reports and manage the platform efficiently.
Full Rollout
Full Rollout
Expand across multiple specialties or facilities. Seamlessly integrate PGxAI alerts and dashboards into daily workflows.
Ongoing Support & Optimization
Ongoing Support & Optimization
Access 24/7 technical assistance, regular platform updates, and performance reviews to continuously refine and improve PGx adoption.
Whats next
Ready to Transform Your Payor Operations?
Contact Our Payor Integration Team
Explore pilot programs, ROI analysis, and best practices for secure data exchange.
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Request a Demo
Discuss your current systems and discover how PGxAI seamlessly fits in.
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Learn More
See how our HIPAA- and SOC 2–certified platform supports real-time precision medicine insights for your entire member base.
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