Products/axsPatient

axsPatient

Resolve

Patient level signal resolution. Resolves payer, economic, clinical, and provider signals tied to verified identities, so your hub, FRM, and analytics teams can act on what they've been missing.

Request Demo
Patient Signal ResolutionaxsPatient
Resolved Patient Signals
Payer Details
rx_payerOptumRx
rx_top_parentUnitedHealth Group
rx_channelCommercial
rx_planFedEx Corp Group Health
rx_plan_modelHMO
mx_payerUnitedHealthcare
Financial Responsibility
rx_total_oop$4,180
rx_deductible_paid$3,200
rx_copay_total$580
mx_total_oop$1,240
annual_est_oop$6,800
abandon_riskMedium
Clinical Risk & Adherence
charlson_index3.2
pdc_latest_yr0.92
is_adherentTrue
rx_risk_scoreLow
rx_comorbidity1.4
activity_statusActive
Coverage Intelligence
is_coveredTrue
pa_reqdTrue
st_reqdFalse
copay_cardEnrolled
is_abandonedFalse
is_hmoTrue
Illustrative data — actual results vary by source configuration
Signal Framework

100+ signals across 10 dimensions

axsPatient delivers a comprehensive patient profile — payer details, clinical risk, financial barriers, coverage intelligence, and more — unified in a single resolution layer.

Payer Details
  • Rx & Mx payer hierarchy
  • Plan, sponsor, channel
  • PBM, processor, controller
  • Formulary, GPO
  • Top parent rollup
Clinical Risk
  • Charlson Comorbidity Index
  • Comorbidity burden (Rx + Mx)
  • Predictive risk score
  • Baseline -> latest delta
Adherence
  • PDC & MPR scores
  • Therapy duration (days)
  • Adherence threshold flag
  • Historical vs latest year
Financial
  • OOP spend (Rx + Mx)
  • Deductible, copay, coinsurance
  • Abandonment risk level
  • Non-adherence risk index
  • Copay card eligibility
Coverage Intel
  • Covered by plan (flag)
  • PA required
  • Step therapy required
  • Claims volume
  • axs plan group linkage
Plan Status
  • Copay card enrolled
  • HMO enrolled
  • Prescription abandoned
  • Medical benefit drug cost
Clinical Coding
  • ICD-10 diagnosis
  • SNOMED clinical terms
  • Physician specialty
  • Place of service
  • Cancer type (if applicable)
Medication
  • Brand name, NDC
  • ATC classification
  • Maintenance / chronic flags
  • Last fill date
  • Patient activity status
Financial Barriers
  • Non-adherence risk index
  • Estimated annual OOP
  • Abandonment count (12mo)
  • Copay card eligible
  • Abandonment risk level
Social & Functional
  • Smoking status
  • Alcohol use risk
  • Exercise adherence
  • Cognitive impairment
  • Physical disability
Capabilities

What legacy tools fragment, axsPatient unifies

Previous-gen solutions split patient intelligence into separate products — e-services, targeting platforms, and analytics modules. axsPatient delivers it all in a single, integrated resolution layer.

Patient Payer Intelligence
57 payer fields — Rx and Mx payer hierarchies, plan sponsors, PBM, processor, controller, formulary, and GPO — resolved from patient-level signals when BPG values are incomplete or missing.
Clinical Risk Scoring
Charlson Comorbidity Index (baseline, latest, delta), Rx and Mx comorbidity burden scores, and a predictive risk score — quantifying chronic disease burden for care management and case prioritization.
Financial Barriers
Non-adherence risk index, estimated annual OOP burden, 12-month abandonment count, copay card eligibility, and abandonment risk level — modeling patient-specific financial access risks.
Adherence Intelligence
PDC and MPR scores (historical average + latest year), therapy duration in days, and the CMS-standard 80% adherence threshold flag — the gold standard for Star Ratings programs.
Coverage Intelligence
Plan-level drug coverage flags, PA and step therapy requirements, claims volume — linked to axs plan groups so you can verify coverage before the claim is ever submitted.
Social Determinants
Smoking status, alcohol use risk, exercise adherence, substance use history, cognitive impairment, and physical disability flags — the social and functional context that shapes care complexity.
Who it's for

Built for the teams asking "which patient should I focus on today?"

FRMs are drowning in growing caseloads. Hub teams lack the context to route intelligently. Analytics teams can't connect patient outcomes to payer decisions. axsPatient gives each team the signals they need.

Hub Operations
Enhance eligibility at intake
Surface benefit design, HDHP status, OOP burden, and coverage details at the point of intake — so your hub team routes patients to the right support program from day one, not after three failed calls.
Field Reimbursement
Resolve missing info, prioritize cases
FRMs need to know which cases benefit most from their attention. axsPatient resolves unknown insurance, flags financial risk factors, and generates next-best-action context for each patient in their territory.
Commercial Analytics
Unblind and enhance payer data
Move beyond plan-level reporting. Understand how benefit design, diagnosis mix, copay burden, and prior auth rates affect patients at the employer-rider level — not just formulary status.
Patient Services & Compliance
Real-time decision support
Power patient assistance program compliance with identity resolution and anomaly detection. Identify maximizer risk, alternate funding eligibility, and government payer indicators in real-time.
Anomaly Detection

Catch what payer data misses

Patient support programs — PAP, hub, copay, bridge, CRM — all feed into patient identity resolution. axsPatient flags anomalies and risks that surface only when patient signals are cross-referenced against payer context.

The result: fraud and abuse detection for program eligibility, true customer cost of acquisition, and best-in-class insights on how market access decisions impact the patient journey.

Risk & Anomaly FlagsaxsPatient
!
Maximizer Risk
High OOP patient on copay card — consider lowering program max
▲
Alternate Funding Required
Medicare patient — request coverage through medical benefit
✓
Program Eligible
Commercial HDHP, deductible met, income-qualified
G
Government Payer for Voucher
Medicaid payer detected — redirect to voucher program
Patient Resolution
Input
BPG: NULL
Blocked CVS Claim
Resolved
PBM: OptumRx
Channel: Commercial
Plan: FedEx Corp
axsPatient

Resolve blocked claims into actionable patient intelligence

Get started

See the patient signals
your team is missing.

Send us a BPG fragment. We'll show you the full patient context that resolves.

Request DemoTalk to our team