CLIENT CASE STUDIES

Leading Pharma Manufacturer, Script Scrubbing Assessment​

A Large Pharmaceutical manufacturer historically outsourced the validation of all claim submission files across Managed Care, Medicare Part D, and Medicaid channels to a third party. The company wanted to perform a current state assessment with requirements documentation and evaluation of alternative vendors and options, culminating in a recommendation and roadmap to implement and deploy the chosen solution. ​

CHALLENGES

After recent merger completion, the company was not confident that the harmonized claim validation process was fully optimized. Some challenges with the existing process included:​
  • Current vendor flagged Medicaid exclusions in error, causing frustration and time-sink in chasing down and verifying exclusions​
  • Concern that the existing vendor did not offer validations against Contract Pharmacy data
  • Difficulty in holding to SLAs, with delay on the vendor’s side causing strain for the company to process and pay rebates within defined payment terms​
  • Vendor turnover reduced knowledge of Payer accounts and individual contract/program complexities, resulting in re-work and potential missed exclusions​

SOLUTION

Marbls conducted a current state assessment and facilitated the RFP and vendor evaluation process by: ​ ​
  • Conducting current state workshops to gather and document requirements for the harmonized rebate process​
  • Developing and distributing RFPs and communicating with vendors that had claims validation solutions and/or 340B validation solutions
  • Detailing Critical Business Scenarios to drive vendor demonstrations​
  • Evaluating RFP responses from vendors for fit/gap analysis​
  • Supporting the company in performing Vendor scoring​
  • Developing Timeline, Implementation Estimates and Future State Architecture​​​

RESULTS

The project culminated with recommendations and a roadmap provided by Marbls to help the company:​ ​
  • Compare and contrast the potential benefits for continuing with a BPO provider vs moving to a SaaS solution and bringing the process in-house​
  • Determine the best overall vendor fit against the company’s requirements, business process, and available resources
  • Equip the organization with a strategic roadmap for implementing and deploying the future state recommended solution​​