Claim Processing

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:

The Invoice/Resubmission text files are imported into a Drug Rebate Management System.  This can be TRG’s system or our clients’.  The data is compared to the submitted invoice package to ensure accuracy.

Validation Testing:

TRG analyzes our clients’ historical drug utilization data to establish trends and develop test criteria.  Our drug rebate validation system is then customized to include tests for each new State, Program and National Drug Code (NDC).  Using these criterion and TRG’s many years of experience, analysts determine which claims are valid and which claims should be disputed.


Claim Reconciliation:

After recording recommended disputes, the Reconciliation of State Invoice (ROSI) and Prior Quarter Adjustment Statements (PQAS) are created. (Paper and/or text file).

Settle Claims:

TRG summarizes the dollars owed for each Labeler Code, State and Rebate Program.  Once invoices are reviewed and approved, TRG will request payments and supply supporting documentation.

Electronic Filing System:

Constructed to best fit our clients’ needs, TRG stores all invoice packages, reports and text in an Electronic Filing System.  The EFS contains PDF copies of each Invoice Submission Package, ROSI, PQAS and Check, and the related text file (Submission, ROSI and PQAS) using the CMS file layouts, all filed under a standard naming convention.