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Validation Services
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Validation
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IHS provides validation services to ensure that claims submitted in data for rebates are accurate and tie exactly to the claims and units billed on rebate invoices.
After IHS standardizes rebate claim data received from PBMs, plans or governmental programs, IHS will:
- Tie-to-invoice
- Load client lists
- Identify aberrant quantities
- Compare claim data to contract terms for additional exclusions
- Apply plan and formulary specifics
- Identify all duplicate claims
- Features flexible duplication logic - set different duplication criteria (number of matching fields) and duplication payment rules (pay none, pay first, pay both) for each contracting entity
- Applies exclusion adjustments to prior invoice periods due to horizontal and horizontal/vertical duplication
IHS converts and de-identifies the data per manufacturer's specifications and then runs claim-level detail that should match the invoice. Once the data is converted, IHS conducts data integrity assurance, looking at dispensing pharmacies, client identification, duplicates and other quantity issues. Once assurance is done, IHS analysts confirm that the data ties to the invoice and conduct additional validation around contract terms, such as eligibility of client and pharmacy, timeframe restrictions, formulary adherence, etc.
This process ensures the integrity of your contracts through contract compliance and invoice accuracy. Once finished, IHS prepares a summary report and provides it back to the client.
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Overview
Validation
