Pharmaceutical companies ought to be well aware that when it comes to reimbursement agreements they have in place with Managed Care/Medicare Part D organizations, the quality of the utilization data submitted to support the entities’ rebate claim is fair at best. The submission of dirty data is a common concern; this applies to both summary plan-level and detailed prescription-level data. A claims data validation process is crucial to limit rebate payments on ineligible or erroneous claims.
Our versatile end-to-end claims data validation methodology, built collectively through people, process and technology, is what your organization needs to ensure contract compliance, reduce risks, reduce revenue leakage and gain greater business insights in this ever-changing environment.
Claims Data Validation is the first and most crucial component of the Rebate Management Lifecycle. This process identifies incomplete and inaccurate claims data, which if not identified and disputed can result in revenue leakage through overpayment, duplicate payment and/or payment on ineligible claims. The exposure from rebate revenue leakage can range from 2% to 16% of the total rebate submitted.
Our approach in assessing current practices and implementing improvements provide significant results including:
We often partner with Life Sciences professionals who may be:
Paragon’s subject matter experts have leveraged practical industry expertise with companies small to large to develop an end-to-end best practice methodology for Claims Data validation. Paragon has guided organizations in assessing current practice and implementing improvements through this methodology to gain significant results.
We possess deep domain expertise in Life Sciences, Commercial Contract Management, Rebate Management, Claims Data Validation, Process Management and Technology to provide your company with an array of benefits, including:
Request a free consultation with one of Paragon's leading industry advisors to discuss the best solution for your organization's unique challenges and goals.