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Medicaid

Ensure accurate and timely claim remittances to Federal & State Governments with Medicaid management software. Reduce fraud and maximize revenue.

Eliminating Compliance Risks with Medicaid

As manufacturers navigate changing government regulations, having all data in a single source lends itself to immediate rebate claim processing, thereby reducing costly interest or penalties. Over the past decade, Medicaid enrollment has grown more than 50% due, in part, to the Affordable Care Act, though with unit rebate amounts updated automatically upon completion of government pricing calculations, manufacturers no longer have to rely on legacy systems that can be lengthy and produce inaccuracies. Throughout the institutional contracting process, manufacturers look for solutions that mitigate the risk of rebate overpayments and ensure timely processing to avoid interest or penalties.

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Features

With the RMaaS delivery model, Medicaid features are continuously being introduced and enhanced to ensure customers remain compliant to changing regulations while incorporating feedback from our customer advisory board to advance best practices. Here are just a few key features of Medicaid:

  • Medicaid claims management
  • Automated disputes and adjustments
  • Pre-loaded 50 URA formulas
  • Formula builder
  • Validations and reasonability tests
  • Regulatory update packs to stay current
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Benefits

Though just one component of commercial strategy, Medicaid provides important benefits for life sciences manufacturers. Customers can expect to receive significant value by experiencing these benefits, among others:

  • Comply and remain current to government regulations
  • Ensure timely processing to avoid interest and manage the inflation penalty on generic products
  • Reduce overpayments in Medicaid rebates through aggregated or Rx-level utilization data validations
  • Diminish fraud, waste, and abuse with predictive analytics
  • Streamline accurate and timely information sharing with states that are able to process electronic ROSI and PQAS reports

What our customers say

“(CMS) substantially increased the alternative unit rebate amount calculation for these line extension drugs…and they are going to add significant rebate liability to manufacturers of line extension products.”

John Shakow, Partner King & Spalding

CMS

THE POWER OF MODEL N MEDICAID FOR THE PHARMACEUTICAL INDUSTRY

Combined with the entire Revenue Cloud for Pharma suite, manufacturers are able to streamline and automate the entire revenue management process throughout the organization. From sales and marketing, finance and contracting, to legal and regulatory, the Revenue Cloud for Pharma suite is the most comprehensive solution available.

ADD-ONS

Accruals Management

Accruals Management is an end-to-end Gross-to-Net solution that seamlessly extracts rebate and chargeback lines from our Revenue Cloud and is loaded into the Accruals application where forecasting and reconciliation modules quickly and accurately calculate Net Sales. Accruals eliminates the need for dozens of spreadsheets and maintains an audit log for compliance. It delivers significant productivity improvements by eliminating manual operations and promotes collaboration by which multiple users may use the solution. It is flexible in its ability to roll up discounts by NDC codes, therapeutic areas, contract groups, or any such hierarchy. Best of all, it is a hosted solution, thereby reducing the total cost of ownership and can be up and running very quickly.

Medicaid Intelligence

Medicaid Intelligence is a self-service reporting solution on the data being used or created on the Powered by N Government Cloud Medicaid application. The data can be sliced and diced to generate valuable insights. The solution enables generation of different types of charts and graphs which help in quickly stitching together a report for management. The reports can be configured and scheduled to run at a set time which would enable users to pre-configure their requirements.

Validata Script Management

The Validata module for Medicaid provides support for Medicaid script validations, which includes basic integration with Model N Medicaid systems, storing and referencing Medicaid pharmacy data, and identifying transactions as Medicaid or Commercial to ensure correct validations are run.

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