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medicaid

Maintaining compliance with Medicaid calculation and reporting requirements is essential to protecting your business and brand

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  • Slight errors in calculations can cause millions of dollars in overpayments or result in costly overcharge penalties.
  • The potential threat of noncompliance can translate into large fines tarnishing your brand.
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The benefits of Model N’s Medicaid solution

Model N’s Medicaid helps you remain compliant and advance best practices with your Medicaid claims process.

reduced risk

Comply with government regulations

Manage and process payments for the federal program as well as state and supplemental programs.

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Reduce rebate overpayments

Streamline your processes to support timely payments, avoid interest penalties, and run validation tests to identify invalid units.

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Streamline information sharing

Produce a consolidated payment package with all the necessary reports in just one click.

$7.35M

On average, manufacturers have paid $7.35 million for a single overcharge penalty since 2012

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A scalable, accurate solution to ensuring Medicaid compliance

Medicaid complies with government calculation and reporting requirements, translates strategy into execution, and optimizes business insights into ongoing operations.

Regulatory Update Packs (RUPs)

Ensure compliance with current guidance. RUPs contain the software and documentation necessary to update and process based on the latest regulatory changes. Stay current on the latest MDRP file format changes from CMS.

Flexible formula builder

Correctly calculate unit rebate amounts (URAs). Featuring 50 preloaded formulas, Medicaid also supports changes in URA calculations with a flexible formula builder.

Automated validations

Identify outliers in claims through aggregated or prescription-level utilization data validations, reducing the likelihood of rebate overpayment.

Streamlined report generation

Easily generate electronic Reconciliation of State Invoice (ROSI) and Prior Quarter Adjustment Statement (PQAS) reports.

Model N's unique approach to improving your entire revenue management process

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Model N Medicaid integrates with other components of Model N’s suite to ensure compliance and accurate payments.

  • Integrates with Model N Validata for Medicaid script-level validations to verify units.
  • Receives up-to-date prices from Model N Government Pricing to ensure accurate calculations.
  • Provides necessary information back to Government Pricing for PHS price calculations.
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