Built for 340B covered entities

The AI agent for 340B referral capture.

OptimNav reads the chart the way your best 340B analyst would. It finds referrals buried in notes and faxes, ties them to contract pharmacy claims, and builds the evidence to defend every one.

Demo with sample records

Scroll to watch it work

01The problem

Referral savings are real. Finding them by hand isn't.

Industry estimates put up to a third of a covered entity's contract pharmacy opportunity in referral prescriptions. Most programs capture a sliver of it, because the proof is buried where no rule can reach it.

The evidence is scattered.

A referral might be an order, a sentence in a progress note, a scanned fax or a portal message. It rarely sits where your software looks.

Rules only see coded fields.

Traditional matching finds referrals entered as structured data. Everything a clinician writes in plain language stays invisible.

Manual review can't keep up.

Tracing one claim through the chart is slow, careful work. Multiply it by thousands of claims a month and it simply doesn't get done.

02Meet the agent

An agent that works the chart, not just the claim.

Follow one prescription from an outside rheumatologist as OptimNav works it from first record to finished proof.

01Read

It reads everything.

For every patient with an outside prescription, the agent reviews the full record: visit notes, orders, scanned faxes, portal messages and consult letters.

02Reason

It understands referral intent.

Clinicians rarely write a referral the same way twice. The agent recognizes one in plain language, along with who it went to, when, and why.

03Match

It connects the referral to the claim.

Each contract pharmacy claim is tied back to the referral behind it: the same specialist, written after the referral, for the condition being treated.

04Verify

It checks your rules, and knows when to ask.

The agent applies your written 340B policy to every claim and scores its own confidence. Clear cases move forward. Uncertain ones go to a person.

05Close the loop

It builds the proof.

Every qualified claim leaves with an evidence packet: the visit, the referral, the prescription, the fill and the consult note, each linked to where it was found.

03Your team, in the loop

Your analysts review decisions, not charts.

The agent does the searching. Your team works a short queue of finished cases, each with the agent's reasoning and a link to every line it relied on.

  • Every conclusion cites its source
  • Uncertain cases always go to a person
  • Your corrections shape the next decision

Claim 7310442

Adalimumab-adaz 40 mg

Recommends qualify

Agent's reasoning

Referral to Dr. A. Reyes found in the Mar 3 progress note. The same specialist prescribed 42 days later, and the consult note arrived by fax on Apr 18.

  • Progress note, line 4Mar 03
  • Contract pharmacy claim, Rx 7310442Apr 16
  • Scanned fax, rheumatology consultApr 18

Try it. This is a sample case.

04Built for scrutiny

A referral claim is only worth what you can prove.

Manufacturers are challenging how a 340B patient is defined, and rebate models arriving in 2027 put claim-level data under a microscope. OptimNav keeps the full chain for every claim it captures.

  1. Visit at your siteYour patient, your care
  2. Referral outResponsibility stays with you
  3. Specialist prescribesWritten after the referral
  4. Contract pharmacy fillThe claim being qualified
  5. Consult note returnsThe loop, closed

Linked to the source

Every piece of evidence points back to the exact record it came from.

Your policy, every time

The same written rules applied to every claim, with no judgment calls left undocumented.

Exclusions explained

Claims that don't qualify keep their reason, so you can show what you left out and why.

05What changes

From spot checks to every claim.

A sample of claims reviewed

Every outside prescription reviewed

Referrals found only when coded

Referrals found wherever they're written

Documentation pulled together at audit time

Documentation built as each claim qualifies

Analysts searching charts

Analysts approving decisions

Every eligible referral. Found, proven, captured.

OptimNav is the referral capture agent for 340B programs.