Medicaid rebate management is a critical yet incredibly cumbersome process for pharmaceutical manufacturers. They face the daunting task of retrieving hundreds or even thousands of invoices from disparate sources before even starting calculations. Manual retrieval workflows no longer meet manufacturers’ needs. Technology enables the efficiency and effectiveness necessary to maintain regulatory compliance.
The cumbersome invoice retrieval process
Pharma companies must retrieve Medicaid and related invoices from 50 states, with each jurisdiction having its own unique programs and invoice portals. Additionally, large pharmaceutical manufacturers often have multiple labelers (affiliated companies/entities and product labels that fall under their brand). Each program and labeler generates quarterly invoices, creating thousands of documents stored in about two dozen portals. States release all the invoices within the same short window, and manufacturers must pay every rebate within 37 days.
Simply retrieving these invoices requires significant time and resources because Medicaid analysts must:
- Log into more than 20 different systems.
- Download thousands of documents.
- Consolidate the invoices.
- Upload invoices to the Medicaid system.
These manual workflows require analysts to spend between two and three weeks gathering invoices each quarter before completing the rest of the rebate management process. Pharma manufacturers need large teams to handle this enormous workload.
Manual processes create the potential for missed invoices and human error, which can lead to significant negative consequences. The larger a pharma manufacturer grows, the more labelers it uses — and the more invoices it must process. States frequently adjust or add new programs, further complicating invoice retrieval efforts, and traditional approaches do not scale. Manufacturers must innovate to meet growing demands and remain compliant. Automation supports the transformation.
Automated Medicaid invoice retrieval
Medicaid analysts spend hundreds of hours navigating portals and downloading documents, only to then re-upload them to their Medicaid processing system. Automated invoice retrieval accomplishes these tasks in a fraction of the time. In fact, using automation to download 1,000 invoices saves 700 hours a year. Some larger pharma manufacturers process thousands of invoices every quarter; automating the process creates immense time and cost savings.
Model N’s Medicaid Automated Invoice Retrieval solution automatically downloads documents across an array of invoices, emailed claims, and portals from states and third-party providers. The software currently covers more than 80% of Medicaid and related programs, and we are working to add more. The tool can run multiple retrievals simultaneously, increasing input productivity and processing speed.
This solution integrates with Model N Medicaid applications to ingest claims without any manual steps. The automation eliminates manual entry errors and allows analysts to jump to the high-value task of processing claims. The platform receives up-to-date prices from Model N Government Pricing, ensuring accurate calculations and alignment with current guidance. Model N is the only company to offer this seamless integration.
Pharma manufacturers could build their own Medicaid retrieval bots, but these require constant maintenance. Any invoice or portal change might break the program, causing retrieval delays and leaving manufacturers on the hook to fix the problem. Model N offers a SaaS-based, multi-tenant solution so companies don’t have to manage their own software.
Our experts have been effectively using Model N Medicaid Automated Invoice Retrieval for several years as part of our managed services. Model N teams identify portal and invoice changes and make platform adjustments so customers never experience disruptions. We keep processes up-to-date and help customers meet deadlines while reducing the time and money spent managing database connections. With our platform, pharma manufacturers can easily accommodate new labeler codes and invoice types and reduce the risk of overpayments, disputed claims, and non-compliance.
Model N supports pharmaceutical manufacturers slogging through the mandatory yet messy Medicaid rebate process. Our solution:
- Navigates increasingly stringent regulations and continuous changes so pharma manufacturers don’t have to.
- Automatically retrieves invoices from portals across programs.
- Integrates data seamlessly with processing systems.
By automatically downloading thousands of documents across dozens of portals and programs, automation eliminates hundreds of hours of manual effort each quarter and reduces compliance risk. As regulations and invoice volumes continue growing, leveraging solutions like Model N’s integrated SaaS platform is critical for scalability, efficiency, and regulatory compliance in Medicaid rebate management.
Learn more about our Medicaid Automated Invoice Retrieval solution to see how we can help you reach your revenue optimization goals.
