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Life Sciences

Bringing together unparalleled healthcare data, advanced analytics, innovative technologies, and healthcare expertise to create intelligent connections that speed the development and commercialization of innovative medicines to improve patient lives.

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Life Sciences
Healthcare

Accelerate digital innovation to enable smarter decisions that reduce cost, modernize patient and consumer engagement, and improve health outcomes.

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Healthcare
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U.S. PROGRESS POINT

A curation of IQVIA's best thinking on topics and trends driving change, disruption, and progress in the United States healthcare market.

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"Decoding DSCSA: Ensuring Compliance in the Pharmaceutical Supply Chain

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Contract & Revenue Management

Rebate Operations

Defend your contract integrity by ensuring adherence to incentive terms and conditions. If you are paying invoices at face value today, you may be paying invalid claims.

IQVIA Rebate Operations services compare summary-level invoices to Claim-Level Data (CLD) to analyze eligibility decisions made by payers to identify and prevent revenue leakage. Our on-demand dashboards and analytical reports give you visibility into prescriptions at the provider level, as cross-referenced to our OneKey National Provider Identifier (NPI) registry.

Learn more about how IQVIA uses data science through Connected IntelligenceTM to protect contract integrity. 

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Locations United States Our U.S. Solutions Life Sciences Commercial Solutions Market Access Solutions Contract and Revenue Management Rebate Operations

Stop paying invalid claims by using data science to validate summary invoices against Claim-Level Data (CLD)

In today’s complex healthcare market, payers are faced with the enormous task of evaluating claim eligibility against a multitude of shifting factors. As a result, a certain degree of claim error exists across virtually all pharmaceutical claims. Unfortunately, for manufacturers, the data that support these eligibility decisions is not available due to invoice summarization.

That’s why IQVIA uses Connected Intelligence with Claim-Level Data (CLD) to analyze each prescription in combination with industry-leading data assets such as OneKey, and our Longitudinal Access and Adjudication Data (LAAD) to establish eligibility. CLD analyses are compared to summary requests and disputes are automatically identified with supporting documentation. Your IQVIA team will assist with tracking and dispute management through resolution.

  • Claim receipt and load directly from payers
  • Superior validation technology using CLD and industry-leading data assets
  • Advanced analytics and reporting dashboards
  • Payment services
  • Dispute management support
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Commercial Managed Care

Support for all commercial managed care programs, including contract management, risk identification, validation, payment, and performance measurement. Industry leading validations include:

  • Terms validation
  • Data integrity evaluation and product validation
  • Duplicate claim identification
  • Ineligible pharmacy / plan identification
  • 340B claim identification
  • Formulary compliance analysis
  • Online dashboards and analytical reporting

Medicaid

IQVIA’s Medicaid Solution services manage the collection of state Medicaid invoices and claim level data. Our full list of services include:

  • Claim-level Validation: IQVIA manages the process of collecting State claim-level data and the application of this data to validate summary State Medicaid invoices.
  • Validation Technology IQVIA’s validation technology is specifically designed for Medicaid programs and fine-tuned for effective 340B exclusion identification.
  • Rebate Processing Services We specialize in data integration, validation technology, and dispute recovery for a complete and scalable solution.
  • Subject Matter Expertise Subject matter expertise and superior knowledge of Medicaid program regulations, state policies, and revenue leakage mitigation.
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Medicare

Support for all Medicare programs, including contract management, risk identification, validation, payment, and performance measurement.

  • Part B
  • Part D
  • Inflation Reduction Act rebates

Industry leading validations include:

  • Data integrity evaluation and product validation
  • Duplicate claim identification
  • Ineligible pharmacy / plan identification
  • 340B claim identification
  • Online dashboards and analytical reporting
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TRICARE & IFF

IQVIA can receive and process TRICARE rebate invoices and calculate your Industrial Funding Fee (IFF) administrative fees.

  • TRICARE rebate validation and payment
  • IFF calculation and payment

Payments

IQVIA can send approved payment requests to your financial systems or authorize payments directly to payers by way of a funded bank account in the form of check or Automated Clearing House (ACH) transfer. Supported payment account types include:

  • High control
  • Block funding
  • Zero balance accounts
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