News & Events

July 13, 2021

IntegriChain’s Claim Level Validation Identifies 1-2% of Medicaid Liability for Life Sciences Manufacturers

Market Uptake for Solution Identifying Revenue Leakage and Improving GTN Accrual Forecasting Accuracy 

$6M Revenue Leakage from a Single State Program Identified by Top-50 Manufacturer

Philadelphia, PA, July 13, 2021 – IntegriChain, delivering Life Sciences’ only comprehensive data and business process platform for market access, today announced significant customer savings and market uptake of its automated claim level validation solution for Medicaid rebate processing by mid-tier and Big Pharma manufacturers. IntegriChain’s Claim Level Detail (CLD) offering delivers data management, script-level scrubbing and validation, analysis, and reporting that enables manufacturers to identify potential revenue leakage due to erroneous and duplicate state Medicaid claims within the claims dispute cycle as well as to improve gross-to-net (GTN) accrual forecasting accuracy. With CLD in place, one top-50 manufacturer identified $6 million in revenue leakage from a single state program, and on average, manufacturers utilizing CLD identify 1% to 2% of Medicaid liability in revenue leakage.

“More than 150 Life Sciences manufacturers rely on us for rebate management, and we are thrilled that they are embracing this new revenue leakage prevention offering,” said Brian Coleman, IntegriChain VP of Product Management. “Before our CLD solution, manufacturers had to verify Medicaid claims through individual state or third-party portals, and many chose to avoid the manual toil of this cumbersome and fragmented process. With our automated CLD offering, we employ advanced automation technologies to retrieve the data and apply data science to scrub and identify problematic claims. Our CLD customers now have rapidly available data to initiate in-cycle dispute resolution to recover lost revenue, eliminating the old ‘pay-and-chase’ model. And those manufacturers utilizing our ICyte Platform can leverage the CLD data to improve the accuracy of GTN accrual forecasting and modeling.”

About IntegriChain’s CLD Solution
IntegriChain offers an end-to-end claim level validation solution, including data management, script-level validation, analysis, and reporting for in-cycle dispute resolution of erroneous and duplicate state Medicaid claims. Employing advanced data technologies including robotic process automation and ETL (extract transform load) in concert with its world-class ICyte data and analytics platform, IntegriChain validates claims at a granular level prior to paying the rebate. The CLD offering ensures product Medicaid eligibility, scrubbing out scripts for terminated products; screens for duplicates within Medicaid and across other channels such as 340B, Managed Care, and Tricare; and searches for aberrant quantity values such as those outside the min/max and those not in expected increments. 

A unique benefit available to manufacturers that use the ICyte Platform is the ability to leverage CLD to further improve the accuracy of GTN accrual forecasting and modeling. CMS requires Medicaid managed care organization (MCO) entities to bill based on the “Date of Service,” but they can report based on either “Date of Service” or “Date of Payment.” This complicates modeling for manufacturers that want to understand the true “Date of Service” as a portion of Medicaid invoice-level data might not be reported based on the correct “Date of Service” period. ICyte improves GTN accuracy by utilizing the CLD fill dates to correct the MCO invoice-level reported utilization periods.

IntegriChain’s CLD offering is available as part of the ICyte Rebate Management solution, and more information is available here: https://www.integrichain.com/products/rebate-management/.

About IntegriChain
IntegriChain is Life Sciences’ data and application backbone for patient access and therapy commercialization. More than 250 manufacturers rely on IntegriChain’s ICyte Platform to orchestrate commercial and government payer contracting, patient services, and distribution channels. ICyte is the first and only platform that unites the financial, operational, and commercial data sets required to support therapy access in the era of specialty and precision medicine. With ICyte, Life Sciences innovators are digitalizing labor-intensive processes – freeing up their best talent to identify and resolve coverage and availability hurdles and to manage pricing and forecasting complexity. IntegriChain is backed by Accel-KKR, a leading Silicon Valley technology private equity firm. The company is headquartered in Philadelphia, PA, with offices in Ambler, PA; Raleigh, NC, and Pune, India. For more information, visit www.integrichain.com, or follow us on Twitter @IntegriChain and LinkedIn.

Contact
Jennifer Guinan, Sage Strategic Marketing, 610.410.8111,  Jennifer@sagestrat.com

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