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I-many Medicaid Rebates™

Meet the Medicaid Challenge

Medicaid claims processing is long and labor-intensive consuming considerable resources for most life sciences manufacturers, and the risks of error are substantial—fines are increasing and the number of firms triggering fines is rising. New state programs are here and on the horizon, burying life sciences companies in a sea of claims-processing complexity and risk.

I-many Medicaid Rebates, one of the I-many Contract Management Suite for Life Sciences™ solutions, manages the full spectrum of compliance with federal, state and supplemental government-mandated programs, such as the guidelines and processes set forth by the Centers for Medicare & Medicaid Services (CMS). The solution automates the management and clerical tasks of the Medicaid Drug Rebate Law, processes invoices, calculates rebates per unit (RPU) and creates payments while providing efficiency, accuracy, reporting and auditing capability. I-many Medicaid Rebates provides quick resolution of disputes for questionable rebates, minimizes revenue loss and improves overall operational efficiency.

Compelling Key Benefits

• Ensures accurate quarterly preparation by allowing users to enter,
  maintain, import and export product information for all drugs eligible
  for Medicaid and associated state programs.
• Users can define rebate-calculation methods leveraging I-many Government Pricing for accurate average manufacturing price (AMP)
  and best price (BP) calculations.
• Includes out-of-the-box calculation methods for the standard Medicaid method, Texas CHIP, New Jersey Senior Gold and others, and provides users the flexibility to create custom calculation methods.
• Automates the entire Medicaid rebate-claims process, from submissions and claims to settlement, while maintaining a complete audit trail of all related claim activity. The solution automates both state- and manufacturer-generated claims processes:
  
  
  State-Generated Claims Processing
  • View submitted claims and enter pay, dispute, resolved and dismissed amounts. Run exception tests, such as prior vs.
    claimed rebate or rebate claimed vs. total reimbursement.
  • Create quarterly product/price and mandated CMS reports,
    such as Reconciliation of State Invoice (ROSI) and Prior
    Quarter Adjustment Statement (PQAS), in ASCII or Electronic
    Data Interchange (EDI) formats.
  • Manage disputed, paid, resolved or dismissed units for a claim. Corresponding dollar amounts are automatically recalculated ensuring they add up to the submitted amount.
  • Combine approved claims with other claims for one-off
    payment.
  
  
  Manufacturer-Generated Claims Processing
  • Resolve outstanding disputes and enter the units to resolve
    (pay) and dismiss.
  • Change pricing, drug category, market date, base AMP or
    calculation method. If the change affects an approved claim, rebate-change claims are automatically created, if applicable.



• Allows users to select approved claims for payment, calculate interest
  on overdue claims and easily combine multiple claims across quarters
  into one payment.
• Stores summarized data across contract programs, states, quarters
  and National Drug Codes (NDCs) and provides views to extract this
  data for reporting purposes.

Click on the following products for more information:

• I-many Contract Manager™
• I-many CARS® NG
• I-many Government Pricing™
• I-many Medicaid Rebates™
• I-many Validata™
• I-many Medicaid Analytics™
• I-many CARS® BI
• I-many Architecture