Compliance services
Clinical R&D
MFG
Risk-Based
Compliance
Commercial
Sales & Marketing
Government Programs
Contracts
CalcPartner
& ClaimsPartner
Assessment &
Audit
COT & PHS
Validation
PCX
Features
ClaimsPartner™
– Medicaid Invoicing Made Easy
PCX
–SALES & MARKETING
PCX –
Government Programs
|
Simplifying the Complex.
Valid Class of Trade (COT) assignment is
the foundation to Government
Programs compliance as it is the critical first step in establishing
accuracy in statutory pricing across the Medicaid, Medicare, VA and PHS
programs. Valid Public Health Service (PHS) eligibility is critical to
ensuring access to the program by eligible entities, as well as Best
Price (BP) integrity in the Medicaid program.
CIS has the right process
Mistakes in COT assignment carry through to all
Government pricing calculations. Often, COT assignment has been based
on information from GPO lists, inaccurate historical information
systems or assumptions based on a customer name; none of which are
adequate to address today's Government Pricing regulatory requirements.
COT errors are widespread in the industry and can cost your company a
great deal, but these mistakes are avoidable.
CIS works with clients to develop the
right process and validation procedures to ensure accurate COT
assignment for direct and indirect customers who maintain valid PHS
eligibility on their PHS contract.
the right
solutions
CIS uses efficient tools and processes, as well as methodology
assumptions based on current guidance and industry best practices, to
provide the assistance and supporting process guidance required to
achieve accurate COT assignments and PHS eligibility validation. CIS
also evaluates COT schemas and the overall process used to assign COT.
CIS' PHS Validation service includes verifying both historical and
current eligibility of PHS entities. If a non-PHS eligible customer
improperly receives PHS pricing, your company may be exposed to
penalties, fines and restatement requirements if, for example, a new
best price is set. In addition, the company will submit inaccurate
information to the Government, which may expose the business to a False
Claims Act violation. Demonstrating strong processes and a third party
review are signs of an effective overall compliance effort.
| GP
Services |
Description |
COT DATA VALIDATION
|
Validates customer COT assignments
in customer master files. Validates COT assignment by utilizing a
proprietary CIS database and methodology based on industry best
practices. Applies COT assignment that is in line with applicable
guidance and regulations. The process eliminates duplicate records,
evaluates naming conventions and may identify historical customer data
issues. The COT validation offering also provides a management report
to identify potential GP risks or other compliance issues based on the
project findings.
|
COT SCHEMA AND DOCUMENTATION
|
Ensures that documentation and COT
definitions (schema) are compliant with regulatory requirements and
industry best practices, as well as accurate and appropriate for a
customer base, contracting strategies, products and GP calculation
methodologies.
|
COT ASSIGNMENT PROCEDURES AND
DECISION TREE
|
Develops and documents a consistent
process for the assignment of COT to new direct and indirect customers.
Provides policies, procedures and a decision tree related to COT
assignment, coordinated with both the commercial and government sides
of the business.
|
PHS ELIGIBILITY REVIEW
|
Provides validation of PHS
eligibility to ensure that both current and past customers are/were
eligible to receive PHS pricing for a specific time period. Giving PHS
pricing to an ineligible customer may, among other issues, establish an
"unexpected" best price.
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