Processing claims quickly and accurately is one of the biggest challenges payers face today in healthcare industry. Huge volume of claims notwithstanding, multiple and incompatible systems requiring significant manual hand offs have made the timely disposal of claims the single biggest burden on operating costs of payers. Add to it the problem of incorrectly filed claims that payers need to handle, leading to choking of band-width on account of re-processing; the problem suddenly becomes even more acute. With state specific regulations penalizing such delays, it has become a matter of survival for payers to figure out the optimal trade-off between analysis one claim warrants versus time it takes to get it through the system.
Rebates and Discounts represent one of the largest line items on Financial Statements of Pharmaceutical Manufacturers, yet the criteria for assessing contracting decisions often lacks the analytical rigor that match the financial exposure. Pre-deal analysis uses inputs from account managers which tend to overestimate both the benefit of contracting and the risks associated of not contracting. This is not a surprise since factors beyond Pharma’s control can impact the actual results, including a payer’s formulary control and related spillover impacts.