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OUR SOLUTION:

MEDICAID
CLAIMS CLEARINGHOUSE

CiiTA’s Astrolabe Claims Clearinghouse
is the outsourced solution for 340B
duplicate discount management.

  • CiiTA works with stakeholders to responsibly
    collect, process and report the data required
    to ensure that 340B claims are correctly
    identified, paid, and reported.
  • CiiTA’s proprietary solution matches 340B
    claims- level data from all stakeholders to
    prevent rebate payment for 340B claims.
  • CiiTA calculates the required appropriate funds
    to recover and invoices the covered entity on
    behalf of the plan, as necessary.
  • CiiTA works with stakeholders as a neutral party
    to ensure the appropriate data and reporting
    are available for review

 

BACKGROUND

  • The 340B program is inherently complicated
    and does not conform to standard, non-340B
    pharmacy processes. As a result, prevention of
    duplicate discounts is difficult.
  • Pharmaceutical manufacturers are required to
    provide 340B discounts on outpatient drugs
    and to pay rebates for prescriptions paid by
    Medicaid. However, manufacturers are explicitly
    not subject to both a 340B discount and a
    Medicaid rebate on the same sale (i.e.,
    duplicate discounts).
  • Astrolabe is the sole independent and neutral
    solution for preventing duplicate discounts,
    while simultaneously protecting trade secrets.

 

Need help Navigating 340B?

You may not have the time or budget to develop the in-house expertise required to effectively manage your participation in the 340B Program. Like most of our clients, you may only have a few minutes a week to spend on 340B. We understand that you’re busy. Let CiiTA be your external subject matter expert. 

Astrolabe Roles

  • The Payer provides a detailed feed of adjudicated
    Medicaid data
  • The Covered Entity or its agent (contract pharmacy or
    third-party administrator) provides a scheduled feed
    of 340B claims-level data necessary to support
    compliant program operation.
  • CiiTA provides tailored, transparent, and impartial
    review of all supporting data to create findings.
    CiiTA also manages reconciliation funds invoicing
    and transfer

Operational Requirements

  • CiiTA and Payer contract to participate in Astrolabe.
    Requirements include:
    — Claims-level data for all claims processed
    — 340B claim payment methodology and payment
    requirements
  • Payer and Covered Entity contract to participate In
    Astrolabe. Requirements include:
    — Data sharing
    — Financial management
  • CiiTA and Covered Entity contract to participate in
    Astrolabe. Requirements include:
    — HIPAA/HITECH privacy agreement (BAA)
    — Data sharing
    — Financial Invoicing

Astrolabe Timing

  • The intent of the solution is to offer regulatory
    compliance and prevent duplicate discounts;
    therefore, the timing of data transfer and processing
    is critical.
  • The Covered Entity (or agent) provides data in a
    predetermined format on a specific schedule.
  • Leveraging CiiTA’s unique and deep 340B expertise,
    Astrolabe maps the data and performs a claims-
    matching review to identify and flag all 340B claims
  • Using an appropriate and transparent payment
    algorithm, Astrolabe calculates the amount to be
    recovered from the Covered Entity.
  • Astrolabe impartially reports on 340B claims to the
    Payer, as well as the Covered Entity and its agent.
  • The Payer inserts the 340B modifier into the required
    utilization file and submits it to the state using its
    standard processes.

Data Security

CiiTA’s data management processes are HIPAA, HITECH
and CCPA compliant.

About CiiTA

CiiTA is the nationally recognized and neutral thought leader in offering transparent support for all stakeholders
in the 340B Program. Our proprietary tools and services help partners across the 340B Program realize results
and remain compliant

Satisfied Clients

quote

Thorough, easy and also fun. I would say that the way of working with you and your folks is very awesome. There’s not many people that I work with that I would text on my own time and ask in a non-work context. I trust you 100%. You’re appropriate, thorough, and nobody calls you names. If anything they want to talk to you more and that’s a good thing.

quote

From an analytical perspective, you understand the data in ways that we don’t. You layer on the statistical aspects that we don’t have.

It’s simple to take data and look at it and see a trend, but CiiTA layers in the knowledge of the covered entity that gives the trend its value.

Develop Your 340B Strategy

CiiTA has, through extensive experience, developed a set of best practices to help guide you through the creation of your 340B strategy. Download our process document to facilitate the development of your strategy.

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