TwinFyRxTwinFyRx Labs
From pharmacy claims to
suspected diagnoses
Five steps from a fill with no diagnosis to a ranked worklist. See what each drug points at and how strongly, run the scan as one SQL statement, and read the result member by member and across the book.
Step 1 of 5
The Diagnosis Gap
What pharmacy claims are missing
Pharmacy claims tell you what a patient is taking — but not why. Rx claims and pharmacy dispensing data normally arrive with no diagnosis field at all. What they carry instead is an NDC — a package-level product code that says nothing clinical until it is normalized to RxNorm. And the medical claim that would carry the diagnosis may not exist yet this year. For risk adjustment, that is a condition a member has and the plan is not credited for.
| On the claimno diagnosis field | After NDC → RxNorm | |||
|---|---|---|---|---|
| member_id | ndc | fill_date | drug_id | drug |
| M-44210 | 49502039471 | 2026-01-12 | 2563971 | 3 ML insulin glargine-yfgn 100 UNT/ML Pen Injector |
| M-44210 | 00093104801 | 2026-01-12 | 861007 | metformin hydrochloride 500 MG Oral Tablet |
| M-58723 | 00904758104 | 2026-01-15 | 1656354 | sacubitril 97 MG / valsartan 103 MG Oral Tablet |
| M-58723 | 00054429725 | 2026-01-15 | 310429 | furosemide 20 MG Oral Tablet |
| M-63091 | 00378514405 | 2026-02-03 | 997229 | donepezil hydrochloride 5 MG Oral Tablet |
| M-71882 | 00378542701 | 2026-02-10 | 310431 | gabapentin 300 MG Oral Capsule |
| M-71882 | 65862000801 | 2026-02-10 | 861007 | metformin hydrochloride 500 MG Oral Tablet |
| M-85446 | 00143996101 | 2026-02-18 | 308135 | amlodipine 10 MG Oral Tablet |
8
fills
0
diagnoses on the claim
8 → 7
NDCs → RxNorm drugs
→
Nothing on these claims says why a drug was filled, so the reason has to come from the drug — and the claim does not name the drug either: it names a package. The two metformin fills carry different NDCs from different labelers and resolve to the same RxNorm drug; metformin 500 mg tablets alone are sold under more than 500 NDCs. Normalize first. Then some drugs say a great deal about why they were prescribed, and others say very little — the next step shows which is which.