PHILADELPHIA--(BUSINESS WIRE)--Revitas, the leader in Enterprise Revenue Dynamics (ERD), today introduced three new modules for its industry-leading script validation solution, Revitas® Validata™. The new Medicaid Script Validation, Coverage Gap Dispute, and 340B Validation modules enable pharmaceutical manufacturers to protect at-risk revenue by reducing rebate overpayments to distributors and channel partners.
Rebate and administrative fee claims are based on millions of lines of prescription-level data, yet many pharmaceutical manufacturers only perform claim validations on summarized, plan-level data, which often contains errors that drive overpayments worth 3 to 10 percent of rebate exposure. The Revitas Validata solution performs comprehensive script-level data validations, eliminating the errors that cause overpayment. For example, one of the world’s largest pharmaceutical manufacturing companies recovers more than $35 million annually through Revitas Validata solution, highlighting the importance of accurate rebate management.
The three new modules enhance the current Revitas Validata solution to provide organizations with more comprehensive revenue protection through improved Medicaid and 340B script validations, and closer management of coverage gap transactions. With these new offerings, manufacturers can be better equipped to identify eligible entities and scripts, ensure accurate and timely payments, and support Medicare Part D “donut hole” disputes to accelerate the recovery of overpayments.
“The recent Affordable Care Act (ACA) mandate to supplement the Medicare Part D Coverage Gap imposes a new financial burden on manufacturers,” said Eric Newmark, Program Director, Business Systems Strategies for IDC Health Insights. “Now is the perfect time for pharmaceutical manufacturers to review their rebate management processes to ensure a higher level of accuracy and better protect shareholder returns.”
The new Revitas Validata Medicaid Script Validation module helps manufacturers eliminate duplicate or ineligible Medicaid submissions while maintaining compliance with Medicaid guidelines. The module processes script-level data to quickly and accurately identify Medicaid-specific claims, and flag those eligible for benefit coordination with a third-party payer.
Due to the narrow payment window associated with the Medicare Part D "donut hole" coverage, pharmaceutical companies must scour script-level data for documented facts in order to support disputes and recover money. The Coverage Gap Dispute module helps companies scrub script-level data, identify and justify payments, manage disputes, and recapture overpayments.
The 340B Validation module allows pharmaceutical companies to facilitate and improve validation of 340B-designated pharmacies and transactions, avoiding payments to ineligible entities that can reset best price for a product and burden manufacturers with high administrative costs in managing recoveries. The module enables pharmaceutical companies to verify transactions for 340B eligibility through the 340B designation provided by NCPDP (National Council for Prescription Drug Programs), ensuring clean and accurate transactions.
“More than 32 percent of the U.S. population relies on government-sponsored health care programs for affordable medical care,” said Jon Brier, Product Line Manager at Revitas. “Pharmaceutical manufacturers must balance patients’ access to the benefits they need with the costs of the government’s role in delivering care. Managing rebate payments can be a costly and time-consuming burden for manufacturers that slows processes and increases the risk for errors that can lead to significant revenue loss. The three new modules for the Revitas Validata solution automate validation of claims at the script level to confirm submission accuracy and manage disputes, thereby reducing the erroneous payments that cause revenue leakage.”
Revitas, the leader in Enterprise Revenue Dynamics, delivers integrated solutions for contracts, pricing, and compliance that drive higher profitability and lower risk. Revitas empowers companies to optimize contract performance by defining, managing, and analyzing complex, multi-tier pricing incentives and enables positive proof of compliance with commercial, financial, and industry requirements. Powered by the secure, scalable, and standards-based Flex® platform, Revitas® applications speed time to market and improve visibility across B2B relationships. Hundreds of organizations across the most highly regulated and challenging industries leverage Revitas integrated solutions to save money, make money, and reduce risk. For details, visit www.revitasinc.com or http://blog.revitasinc.com/.