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Overall contract flow (Receiving data from our customers (as an invoice)…
Overall contract flow
Receiving data from our customers (as an invoice)
Send that data to IT to load into Validata (DLR) (sometimes through email or through FTP depending on the account)
Once DLR is received from IT, validation is completed, based on the list from Stan
Exported from Validata into ModelN
It arrives at submissions
Approve it
Push to adjudications
Check if pricing is accurate based on contracts (through push of a button)
Identify discrepancies, pay the calculated amount
5 more items...
Checks the date to verify if claims are meant for this quarter or a back-bill
1 more item...
Cannot do validation at our end because of unavailability of patient persona/category level data
Validation (standard and contract specific ones)
Invoice into a 3rd party (IQVIA) to start the validation of the formulary (shared through FTP)
They send a file to IT after validating the formulary
Formulary is uploaded into ModelN
There are contractual terms on when the invoices need to come in. This is verified by contracting team.
Most data comes in a standard format. But some don't come in NCPDP format
Receiving the contract from the contracting team
Setting the contract up in the system
System has other master data such as product, pricing, eligibility, contract etc.
Systems arent really designed to execute value-based contracts
Have to figure work around on how to set up value based contracts with the existing system
There could be different price groups for each quarter and can get challenging to set up
It gets complex because there is a lot of data points to be handled
Activation of contract
Amendments to the contract can happen
VBC is an amendment to the existing contract
Problem of backdating is complicated (cant set it up until signed, lot of back and forth between legal teams)