Managed Services & Business Process Outsourcing

Riparian industry experts identify, implement, and execute best practices for a wide variety of critical business operations

Cost-Effectiveness and Scalability:  We recognize that the nature of some of our business functions requires us to scale up during certain points in each month and/or quarter, and that maintaining the FTEs necessary to meet the “peaks” in activity is expensive and inefficient, as well as the inherent challenge of ramping up staffing when something unexpected comes up.

Accuracy and Consistency:  We have established methodologies, systems, and process controls in place that are designed with accuracy and consistency in mind.  We provide meaningful reports that enable our clients to understand both the results and the key “drivers” behind those results.

Extension of the Team:  Our client interaction model is designed to make us an extension of our client’s team.  We do not operate as a stand-alone team that is siloed off from the changes that are occurring in our client’s business and/or the day-to-day issues that arise in its operations.

Why Riparian?

We bring to bear comprehensive solutions for our clients that are specifically designed to meet their needs.  We don’t try to fit our clients to our model; we evolve our models and approaches to best suit our clients’ needs.  And we have deep SME in relevant areas that we are able to bring to bear on every managed services project.

 

GOVERNMENT PRICING SERVICES

  • Calculation and reporting for the Medicaid Drug Rebate Program ("MDRP"), Medicare Part B, VA/FSS Pricing Programs, and 340B Drug Discount Program
  • State Reporting Requirements
  • Government Pricing ("GP") Programs Restatement Submissions
  • Branded Rx Drug Fees
  • Calculation Mechanics
  • Trending and Threshold Variance
  • Data Validations and Profiling
 

Efficiencies and Benefits +


  1. Reduced cost to implement GP Systems
  2. Reduced cost to build reports inventory
  3. Reduction in size of GP department staff
  4. Customizations to GP Calculations and Reports
  5. Support from GP subject matter experts for all questions and requests

REBATE CLAIMS   PROCESSING   

  • Medicaid
  • State Pharmaceutical Assistance Program ("SPAP")
  • Medicare Part D Coverage Gap
  • Tricare Retail Pharmacy ("TRRX") Program
  • Payment Validation and Adjudication
  • AIDS Drug Assistance Program ("ADAP")
  • State Supplemental
 

Efficiencies and Benefits +


DISPUTE PREVENTION BEST PRACTICES

  1. Reduced number of Future disputes
  2. Increased success rate of disputes
  3. Quality of policies and SOPs

CLAIMS REVIEW PROCESS

  1. Less time to identify discrepancies
  2. Quality of Validation Logic

DISPUTE EXECUTION

  1. Reduced time to prepare ROSI/PQAS
  2. Documentation records

FAILED DISPUTE ESCALATION

  1. Expert advice on best options
  2. Increased performance during hearings

3rd PARTY DATA MANAGEMENT

  • Master Data Management and Validation
  • Competitor Pricing and Sales Database Maintenance
  • State Medicaid Utilization Data
  • HCP Prescribing Data                               

 

 

Efficiencies and Benefits +


  1. Reduced time from higher value work
  2. Increased refresh rate and data quality
  3. Better organization of data
  4. Validation of data quality
  5. Visibility to purchasing patterns
  6. Increased sales force/bid effectiveness

 

 

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