Medicaid Rebate Invoice Validation demo
Each quarter's state Medicaid invoices are scrubbed line by line against the claim-level data; suspect units turn red with their reason and their disputes draft themselves, evidence attached. 1:15
What the demo shows
A government pricing solution for rebate teams that checks each state Medicaid invoice line.
Agents read each CMS-R-144 state invoice, match every line to the state's claim-level data, the HRSA Medicaid Exclusion File and plan rebate files, and show invoiced units against the units the claims support. Suspect lines turn red with their reason; a dispute is drafted for each with its utilization evidence. The rebate manager approves, the letter and the CMS-304 lines write themselves, the undisputed amount is paid before day 38, and every dispute is tracked until the state credits it.
Transcript
- Medicaid Rebate Invoice Validation checks each state Medicaid invoice line by line for pharma rebate teams.
- 51 states invoice every quarter, and each must be paid or disputed within 38 days.
- New York's invoice arrives, 24 lines, $51.7 million.
- Lena starts the scrub.
- Agents match every line to the claim-level data.
- Fourteen lines spike ten times on units, each in red with its reason.
- Kestrel Family Health's late claims bill 20 pens for a two-pen prescription.
- One-click drafts 14 disputes for $0.3 million, each with its evidence.
- Lena approves. The letter writes itself, and each dispute is tracked until the state credits it.
- Build on Botminds, agents, data, screens, and governance on one platform.
Transcribed from the film’s narration. Captions are on the player.