Manufactures submitting a check for payment of their current invoice must include a ROSI documenting the invoice, program, and amounts to be applied. A PQAS should also accompany the payment when the prior quarter is paid.
Once received, check amounts are allocated at the NDC 11-digit level by the drug rebate system. If the check is not fully allocated then the rebate system lists the line items in dispute. Next, an extract from the rebate system is pulled containing claim details for disputed NDCs and automatically provided to the manufacturer. It is the manufacturer’s responsibility to review the claim detail extract and provide any additional information to resolve the dispute. When resolving disputes, the manufacturer must:
- Contact CMS to correct any discrepancies in the URA submitted to CMS
- Correct the ROSI or PQAS form and resubmit it to Conduent if there are any discrepancies in the URA
Discrepancies regarding units dispensed are resolved on a case-by-case basis by Conduent in collaboration with the manufacturer. Direct questions involving dispute resolution to Conduent.