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Industry Solutions
For more than 25 years, Model N has been the leader in end-to-end commercialization, revenue optimization, and compliance for pharmaceutical and medtech innovators.
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Whitepaper
Solution Brief
Maintaining compliance with Medicaid calculation and reporting requirements is essential to protecting your business and brand
- 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.
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.
Comply with government regulations
Manage and process payments for the federal program as well as state and supplemental programs.
Reduce rebate overpayments
Streamline your processes to support timely payments, avoid interest penalties, and run validation tests to identify invalid units.
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
Some of our customers
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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
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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Related resources
2025 State of Revenue Report
The 7th annual State of Revenue Report reveals the power of data and analytics in optimizing life sciences and high-tech revenue. VIEW Whitepaper
Government Compliance Solution Brief
Ensure compliance with government regulations VIEW Solution Brief
