TRG provides Medicaid Drug Rebate Services
We organize rebate payments and enhance relationships with invoice providers, so pharmaceutical manufacturers can spend less time on paperwork and more time on their business.
Invoice Normalization
Invoice Normalization
TRG eliminates the disorder of the rebate process by collecting, consolidating and standardizing quarterly MDRP, MCO and SPAP invoices.
Read MoreClaim Processing
Claim Processing
TRG carefully records and passes each claim through customized validation testing before payments are made, with results organized in an electronic filing system.
Read MoreDispute Resolution
Dispute Resolution
TRG examines current and historical drug utilization data for invoice errors and negotiates on behalf of clients to recover overpaid monies.
Read MoreDepartmental Support
Departmental Support
TRG provides support with monthly and quarterly pricing, payment projections, program compliance and easy-to-use reporting tools.
Read MoreThe Rodenhizer Group
With the increasingly regulated Medicaid Drug Rebate Program (MDRP), the growing number of Managed Care Organizations (MCO), and the expanding list of State Pharmaceutical Assistance Plans (SPAP), meeting government drug rebate requirements is a real challenge for every drug manufacturer. TRG helps address these challenges with a highly automated approach built to handle increased volume and adapt quickly to change.
Our goal is to give clients a simple, efficient path through drug rebate management. TRG has worked in government rebates since 2000, developing a system to bring order to quarterly rebate payments, building relationships with invoice providers, and evolving alongside our clients' needs. Manufacturers rely on TRG's experience for accurate, timely rebate payments — reducing overhead costs and freeing internal resources for other priorities.
About Us
The Rodenhizer Group is a business process outsourcing firm that pharmaceutical companies rely on to manage all or part of their drug rebate departmental functions. Our mission is to be a complete solutions partner for our clients.
We have over two decades of experience
Our founder, Craig Rodenhizer, was introduced to claims processing while working at The Travelers Insurance Company in 1991.
A call to help a struggling claims audit and overpayment recovery unit was all it took — once Craig got a taste of the work, he was hooked.
1990s
After developing a proven process to scrub claims data for The Travelers, it was time to offer the service to the world. Craig left The Travelers, partnered with three good friends and colleagues, and hit the pavement.
The team soon met Ron Rogers, Director of Pharmacy Programs for the Minnesota Department of Human Services, a Medicaid Drug Rebate Program expert. The following months were spent developing a process to help Medicaid agencies detect and correct errors in prescription claims data and resolve disputed rebates.
The Kentucky Department for Medicaid Services became the first client. Kentucky had $35 million in disputed rebates from 1991 through 1996. After a series of validation testing and pharmacy audits, the prescription-level claim errors were corrected: $28 million of the disputes were found to be justified, and the remaining $7 million was collected.
2000s
While reviewing Kentucky's rebate history, it became clear that many drug manufacturers were being overcharged and paying too much in Medicaid rebates. With this knowledge, TRG began offering overpayment recovery for manufacturers — work that proved to be a strong fit, full of new opportunities.
Through overpayment recovery for large clients, TRG gained a deeper understanding of why errors occur within the Medicaid rebate process and how to prevent them, witnessing firsthand how quarterly invoices of varying media types flooded clients' government pricing departments. This led to automating the process of recording invoices and normalizing data for faster, more accurate payments.
2010s
As TRG earned the confidence of its clients, its responsibilities grew. Processing quarterly invoices evolved into producing monthly and quarterly reports, and soon TRG was calculating pricing and producing rebate projections.
Working closely with clients continues to reveal opportunities for improvement. From everyday details to large-scale problems, the goal remains the same: developing solutions for every client's needs.
Services
The Rodenhizer Group has provided comprehensive drug rebate management services for pharmaceutical manufacturers since 2000. Over the years, clients have rewarded that commitment by entrusting TRG with more and more of their departmental needs. Here is a summary of what we do today.
Data Collection and Invoice Normalization
TRG eliminates the chaos of rebate payments by collecting, consolidating and standardizing quarterly MDRP, MCO and SPAP invoices.
- Receive, record and organize quarterly drug rebate invoice packages
- Create submission text files
Claim Processing and eFile System
TRG carefully records and passes each claim through customized validation testing before payments are made. Clients can rely on timely, accurate reconciliation and are provided with copies of all claim documents organized in an electronic filing system.
- Create rebate claims
- Validation testing
- Claim reconciliation
- Settle claims
- Electronic filing system
Over Payment Recovery and Dispute Resolution
TRG examines current and historical drug utilization data for invoice errors. Once claims have been disputed, TRG negotiates on behalf of clients to recover overpaid monies and prevent future overpayments.
- Overpayment detection and recovery
- Dispute resolution
Departmental Support
Clients' needs are always changing, and TRG has adapted to satisfy them — providing support with monthly and quarterly pricing, payment projections, program compliance and easy-to-use reporting tools.
- Average Manufacturer Price (AMP)
- Quarterly AMP and Best Price (BP)
- Quarterly supplemental pricing
- State-specific reporting requirements
- Revitas Medicaid Rebate System support
- TRG RebateAware system support
- Monthly payment projections
- Ad hoc reporting
Recent Projects
TRG has been performing the tasks required of a drug rebate department for many years, continually eliminating inefficiencies and sources of potential error through automation. Here are a few examples.
RebateAware
RebateAware is an integrated data management system that gives clients access to their own data for collecting, processing and reporting on drug rebate information, streamlining invoicing and helping ensure the accuracy of rebate payments. Here is a sample of what it does today:
- Accrual
- AMP Trends
- Awaiting Check
- Business Unit Contacts
- Check Payto Address
- CMS State Contact File
- Contracts – Active
- Rebate Cumulative Detail
- Rebate Cumulative Summary
- Interest Calculation
- New Jersey Senior Gold Fix
- Paid Period Report
- PHS Pricing
- Product CPI
- Product Pricing
- Products Terminated
- Rebate Per Unit Calculation
- Rebate Claim Summary
- Rebate Claim Detail
AMP Validation Tool
A great deal of data goes into the monthly AMP calculation, and clients wanted a tool to simply validate the prices, giving them a higher level of confidence before reporting to CMS. TRG built an application that shows the monthly history of Direct Eligible Sales, Indirect Ineligible Sales and Discounts, making it easy to scan the past and see the cause of any fluctuations.
eFile System
The electronic filing system contains a complete history of quarterly rebates — from the invoiced package to a copy of the check. Within each Labeler Code folder are sub-folders for the State, then the Program, and each Program sub-folder contains up to eight files using a consistent naming convention.
Quarterly Price
Is the quarterly WAC the value at the beginning or end of a quarter? That depends on the contract, and since the definition can vary, TRG built a simple application that provides both. Import the history of prices with effective dates and the tool calculates the Price (start of quarter) and Price2 (end of quarter) for every quarter from the oldest date to the current one.
Contact
Thank you for your interest in The Rodenhizer Group. We're happy to answer any questions or provide an estimate — just give us a call.