Wednesday, September 15, 2010

MDRP 2010 Conference - Operational Process for the Extension of Medicaid Rebate to Medicaid Managed Care Lives

David Iuliani – sanofi-aventis
Edward McAdam – Daiichi Sankyo
Jay McKinley - Cephalon

Put your data into your system in a way where you are thinking about how you want that detail back out. Looking at it another way; with the new Managed Medicaid units coming through from the states your set-up of your systems is vital to getting the output of the detail correctly.

Manufacturers have begun to see all types of invoices coming in for payment. Some states have done different invoices per plan, while others are submitting two invoices (one as Medicaid and one as Managed Medicaid), and still another state has indicated that their invoices will be rolled-up into one.

The different types of invoicing poses a problem in how you set up your system. Do you put all of the invoices into your system as one from each state, or do you set up your system to have different invoices that pull into one check request? And if you have different invoices that get connected together within the system will your finance department cut one check for all invoices or will your systems relay the information that these linked accounts should be paid as separate checks. And if the state is segregating all plans to have each on a separate invoice will you be required to make check requests and cut a check for each?

At this point it appears that the states are still trying to feel their way through this and working on the Managed side of the business to pull the information they need to invoice you. Until all states have sent their new Medicaid/Managed Medicaid invoices, your best bet is to be prepared for all scenarios and think through your potential process changes now.

Not to add to your plate, but I will… also think about the fact that the state of Arizona (which many of us have not had to address each quarter) has always been Managed Medicaid. How is that going to affect your systems? And think about how you will handle the double dip (which are allowed across Medicaid and Managed Medicaid) units when you dispute on one side. Do you have to dispute on both sides and will the disputes be concurrent instead of one side having to be a historical dispute?

Happy Processing!

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