Calculate, settle and reconcile every rebate program.
Rebates, admin fees, wholesaler service fees, price differentials and access payments, set up as rules instead of spreadsheets. Every calculation runs from your contract terms, eligibility rules and sales data, and every invoiced amount can be checked against the number you calculated.
$2B
in rebates, fees and access payments calculated annually
1,400+
active rebate programs under management
1,200
trading partners settled with
$42B
in contract sales under management
Hundreds of formulas, and every payment has to be right.
Every program has its own tiers, thresholds and fees, with its own product, contract and member eligibility. Some you pay on your own calculation; others arrive as an invoice you have to check. For managed care, the rebate rests on utilization data supplied by the plan being paid.
How iContracts solves it.
The challenge
How iContracts handles it
Every contract is its own formula: tiered, market share, price protection, admin fee, wholesaler service fee, data fee.
A library of rebate types. Each rebate or fee in your contracts is set up individually, using configurable rules for common industry scenarios.
Managed care data comes from the payer. Managed care and Tricare rebates rest on utilization data the plan submits.
Utilization validation before payment. Uploaded claim data is validated for duplicate records, invalid plan IDs and more before any rebate is calculated on it.
Eligibility is different for every program. Products, contracts and members change from one rebate to the next.
Eligibility defined on each rebate. Product, contract and member eligibility (plan ID for managed care) is set on every program and applied in every calculation.
Some partners invoice you, and their number isn’t always yours.
Calculated vs. invoiced comparison. Check each invoice against your calculated amount, then upload adjustments to true up to the invoice once it passes a sanity check.
Partner questions turn into negotiations.
Reproducible calculations with summary and detail backup, so questions are answered with facts.
Plus: monthly, quarterly or contract-cadence schedules, open vs approved reporting by look-back period, and settlement through to payment.
Payment reporting, built in
Looking for Medicaid rebates? State invoices (ROSI and PQAS) are validated, adjustment and dispute codes applied, and payment and dispute reports sent back to the states on our Medicaid Rebates page. [Link: Medicaid Rebates]
What we validate
- Product, contract and member eligibility
- Plan ID eligibility (managed care)
- Duplicate records in utilization claim data (managed care)
- Invalid plan IDs and other invalid utilization records (managed care)
- Calculated vs. invoiced amounts, with a sanity check before true-up
- Tier and volume thresholds
- Market share attainment
- Price protection triggers
- Admin fee rate against contract
- Calculation retained for audit
The value
- Catch bad managed care data before you pay. Recovering money afterward almost never happens.
- Check every invoice against your own number. Calculated vs. invoiced comparisons surface the gap before you settle.
- Every rebate type configured once. Tiers, thresholds, admin and access fees, data fees and price protection run as formulas, not spreadsheets.
- Scale without spreadsheets: 1,800+ calculations run every month
Rebates & Fees Managed Services Process
From program setup to settlement: your analyst manages every step.
Managed on your calculation and payment schedule, for commercial and managed care rebates.
Rebate programs are set up to match your agreements and maintained as they change.
- Tiers and thresholds, netting of paid rebates, wholesaler fees, admin fees, access and access admin fees, data fees, enterprise fees, price protection and more
- Bona fide and non-bona fide fee calculations, approved and paid in iContracts for government pricing and downstream reporting
- Calculation and payment schedule managed by your analyst
Setups and sales basis checked for eligibility and integrity before calculation.
- Monthly checklists for commercial and managed care processing, tracking due dates from calculation through approval and reporting
- PBM utilization analysis to confirm the right template uploads for managed care rebates
- Managed care utilization validated for duplicate records, invalid plan IDs and more
Rebates, fees and access payments calculated against your contract terms.
- All sales data loads from Core confirmed and finalized by your analyst team before calculation begins
- Calculations prepared for your review and approval
Results reviewed for trends and variances before they reach you.
- Trend analysis reports
- Analytical variance review, with true-ups created and loaded when needed
You review calculations and approve them for payment.
- Client review
- Approval to pay
Payments and true-ups prepared, with detailed backup for each trading partner.
- Payment preparation
- True-ups
- Partner backup reporting
Every calculation backed up and reportable, at summary and detail level.
- Full detail and summary backup reports for every rebate calculated
- Open vs. approved rebate analysis and management by period
- Trending payment reports
- Rebate comparison tool: incoming invoices vs. calculated sales basis