Claims Data Validation Solutions


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.

WHAT IS CLAIMS DATA VALIDATION?


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:

  • Increased accuracy of contract performance evaluations
  • Increased accuracy of rebate payment
  • Decreased Revenue Leakage
  • Stronger business & technical process workflows with control points
  • Process improvements and efficiencies
  • Recommendations for enhanced validations
  • Optimization of Claims Validation System
  • More reliable data insights

WHO CAN BENEFIT FROM CLAIMS DATA VALIDATION?

We often partner with Life Sciences professionals who may be:

  • Responsible for claims data validation & rebate management
  • Looking to improve reconciliation and reporting of rebate data
  • Trying to streamline the end to end rebate process
  • Seeking to drive greater rebate program productivity and cost savings
  • Looking to leverage data to gain greater insights on contract performance
  • Wanting to evaluate effectiveness of rebate strategies

HOW WE HELP WITH CLAIMS DATA VALIDATION

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.

Our Team Can Help You:

  • Align business rules, business process and business insights to create an adaptable solution for a changing and complex environment
  • Optimize the holistic solution joining cross-functional processes for an end-to-end solution
  • Develop a comprehensive Claims Data Validation methodology built through people, process and technology
  • Drive improved data visibility and reporting to enhance business insights and preserve revenue
  • Developing analytics capabilities that allow you to capitalize on information assets
  • Improve accuracy of reporting and flexible access to data, when and how you need it
  • Develop a unified, comprehensive communication and collaboration plan for greater productivity and accountability
  • Institute ongoing, disciplined processes to help maximize profitability of your revenue management stream

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:

  • Increased productivity through streamlined internal workflows
  • Improved auditability through accessible, accurate and consistent data
  • Greater data integrity
  • Enhanced data insights around contract performance
  • Reduced administrative costs from more efficient processes and data accessibility
  • Better compliance and risk avoidance through systematized information management
  • Available access to customer supplied data results in higher customer-centricity
  • Revenue preservation through reduced revenue leakage
Need Help Finding the Right Solution?

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.

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