Validata

Validata is a script-validation tool from Model N designed for pharmaceutical manufacturers. It is used alongside Model N Payer Management to validate payer rebate claims data, reduce overpayments, and maximize revenue from payer contracts. The tool is intended for pharma companies managing large numbers of payer contracts across managed care, Medicare, Medicaid, Tricare, Coverage Gap rebates, and the IRA-mandated Manufacturer Discount Program.

Pharma manufacturers face a complex web of rebate contracts with hundreds of payers. Payers frequently provide low-quality, inconsistently formatted, and erroneous claims data. As rebates and therapies grow more complex, so does the claims data used for rebate processing. Overpayment risk is further elevated by exposure to overlapping payer and regulatory markets. Validata addresses these challenges by scrubbing invalid claims from payer data before payments are made.

Core Benefits

• Increased confidence: Supports payment of only the right claims, at the right time, for the right amount, helping to optimize revenue.
• Reduced risk: Validates payer rebate claims, identifies duplicates, and reduces claims where payments were made to the wrong market segment.
• Greater flexibility: Manages multiple file formats and allows validations to be configured to meet specific business requirements.
• Increased efficiency: Keeps claim validation activities running smoothly to support compliance and auditability through pre-configured and configurable capabilities.

Key Features and Capabilities

• Script-level validation: Resolves errors and ambiguity in payer data when processing managed care, Medicare, Medicaid, Tricare, Coverage Gap rebates, and the IRA-mandated Manufacturer Discount Program.
• Self-service dashboards and reports: Generates insights into contract performance and compliance, and provides visibility into new channels and opportunities.
• Modern interface: Centralises data and reporting management, enabling users to process claims properly and in a timely manner.
• Accurately identifies duplicate and erroneous claims.
• Ends revenue leakage in payer contracting and rebating processes.
• Provides detailed visibility across all channels to support revenue optimisation.
• Supports adherence to complex government pricing regulations.

Available Add-Ons

• Formulary Compliance: Automates formulary validations to improve patient access, reduce revenue leakage, and strengthen payer relationships.
• 340B Vigilance: Extends validation capabilities to identify and manage prescription data from commercial and government payers where product was acquired at a 340B discount and submitted for a rebate.
• Medicaid Automated Invoice Retrieval: Automates the retrieval of Medicaid invoices and claims for more accurate and faster rebate processing.

Related Products

• Payer Management: Validata is designed to work directly with Model N Payer Management to enforce agreement terms by validating all payer and payer-like claims data.
• Provider Management: Provides real-time visibility and insights into institutional contracting to maximise revenue and ensure contract compliance.
• Intelligence Cloud: Supports data-informed decisions using AI/ML, analytics, and reporting for revenue and channel management.

Validata is delivered as a cloud-based solution. It is positioned as part of Model N's broader Revenue Cloud for Pharma portfolio, which also includes Government Pricing, Medicaid, State Price Transparency Management, and other pharma-specific products. The tool is intended to help pharmaceutical manufacturers prevent costly errors, late fees, and overpayments while maintaining compliance with government pricing regulations.