TwinFyRxTwinFyRx Labs
From pharmacy claims to
suspected diagnoses
Walk through five steps that turn incomplete pharmacy claims into ranked diagnosis signals. See the gap, explore the rules, watch them fire in real time, and understand how clinical signals combine at the member and population level.
Step 1 of 5
The Diagnosis Gap
What pharmacy claims are missing
Pharmacy claims tell you what a patient is taking — but rarely why. Diagnosis codes on Rx claims are frequently missing, nonspecific, or copied from the last encounter. For analytics teams building patient cohorts, this is a massive blind spot.
| member_id | drug | fill_date | dx_code | dx_description |
|---|---|---|---|---|
| M-44210 | Metformin 1000mg Tab | 2025-01-12 | — | Missing |
| M-44210 | Empagliflozin 25mg Tab | 2025-01-12 | — | Missing |
| M-58723 | Atorvastatin 20mg Tab | 2025-01-15 | Z79.899 | Other long term drug therapy |
| M-58723 | Amlodipine 5mg Tab | 2025-01-15 | Z79.899 | Other long term drug therapy |
| M-63091 | Duloxetine 60mg Cap | 2025-02-03 | F32.9 | Major depressive disorder |
| M-71882 | Gabapentin 300mg Cap | 2025-02-10 | M54.5 | Low back pain |
| M-71882 | Metformin 1000mg Tab | 2025-02-10 | E11.9 | Type 2 diabetes without comp. |
| M-85446 | Amlodipine 5mg Tab | 2025-02-18 | — | Missing |
37.5%
missing diagnosis
25.0%
nonspecific (Z-code)
62.5%
not actionable
→
M-44210 is on Metformin and Empagliflozin — two diabetes drugs — yet has no diagnosis code. M-58723 shows "other long term drug therapy" for a statin + CCB combo. The clinical signal is hiding in plain sight. Suspecting rules extract it.