Overview: Kalderos’ Reversal Attribution feature is designed to enhance transparency and efficiency in managing rebate claims for pharmaceutical manufacturers. This feature addresses key pain points related to the attribution of claim reversals, helping manufacturers better understand and manage claims that have been reversed by state Medicaid agencies before disputing, after disputing (through performing a claims refresh), or through Kalderos logic enhancements
Key Challenges Faced by Manufacturers:
- Uncertainty in Reversal Attribution: Manufacturers often face difficulties determining why a claim has been reversed. Was it the result of a state agency action, a claims refresh, or a logic update by Kalderos? Without this clarity, it's challenging to manage claims accurately.
- Loss of Dispute Status Context: When a claim is reversed, vital information about its previous status is challenging to track, such as whether the claim was in dispute or had been agreed to for credit. This leads to confusion in how to address reversed claims.
Kalderos Reversal Attribution Solution:
- Enhanced Visibility: The Reversal Attribution feature provides full transparency into how and why a claim was reversed, detailing whether it was due to a state update or a logic update from Kalderos, and whether or not these happened before or after disputing. This insight allows manufacturers to understand the previous status of the claim before it was reversed.
- Streamlined Dispute Resolution: By surfacing the reasons behind claim reversals and the context of the claim's history, manufacturers can reach dispute resolutions (e.g., closing Open and Impasse claims) faster and with greater confidence. This minimizes delays in processing and ensures timely closure of claims
Key Benefits for Manufacturers:
- Improved Claim Management: With accurate insights into claim reversals, manufacturers can better manage their open disputes and ensure the integrity of their rebate management process.
- Increased Trust and Transparency: By providing a clear understanding of claim reversals, Kalderos fosters greater trust between manufacturers and state Medicaid agencies.
- Optimized Revenue Capture: Manufacturers can confidently identify “won” disputes leading to more accurate and optimized revenue capture from reversed claims.
Why Kalderos? Kalderos’ Reversal Attribution feature is built on a foundation of transparency, accuracy, and efficiency. Our goal is to help manufacturers simplify their rebate management processes, resolve disputes faster, and ultimately confirm “won” disputes as they are removed from the CLD, from eligible claim reversals.
For more information or a demonstration of the Reversal Attribution feature, please contact your CSM