03 Compliance

Compliance-Focused
Validation

Most rebate programs validate at the program level. VativoRx validates at the claim level — so every eligibility determination has a documented reason behind it, not just a program flag.

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Encrypted File Transfer · HIPAA-Aligned Process · No PHI for Initial Analysis · HITECH-Aligned · Security Assessment Ready · Encrypted File Transfer · HIPAA-Aligned Process · No PHI for Initial Analysis · HITECH-Aligned · Security Assessment Ready

The Challenge

Why Validation Matters

Rebate eligibility decisions made without a documented methodology create a quiet compliance risk. The risk isn't usually fraud — it's the inability to explain, consistently and specifically, why a claim was included or excluded when someone asks.

That question comes from auditors. It comes from finance. It comes from boards. And when the answer requires reconstructing logic after the fact, confidence in the entire rebate program takes a hit.

What We Do

Consistent, Traceable Eligibility Decisions

VativoRx applies a structured validation framework designed to produce decisions that hold up — not just at the moment of submission, but under internal or external review at any point after.

Each claim goes through a multi-layered validation process that evaluates manufacturer requirements, regulatory alignment, duplicate discount exposure, and purchasing structure — ensuring every decision is both accurate and defensible.

How The Validation Model WorksValidation Model

Validation in Practice — Four Core Layers

Manufacturer Program Criteria

Claims evaluated against each manufacturer's specific rebate program requirements, not a generic eligibility filter. The criteria applied to each submission are defined at the program level before review begins.

CMS & Regulatory Alignment

Review against applicable CMS Part B requirements where relevant to the claim environment. Ensures submissions are consistent with federal program rules and reduces exposure to regulatory non-compliance.

340B & Duplicate Discount Exclusion

Systematic exclusion of claims that would create duplicate discount exposure — a common gap in less rigorous programs. Protects organizations from the compliance risk that comes with overlapping program participation.

GPO & Purchasing Structure Validation

Alignment with GPO contract terms to confirm eligibility within the correct purchasing channel. Purchasing structure is validated as part of the claim review, not assumed based on account type.

Process

Audit Readiness

Three things make a validation process defensible: documented rules, consistent application, and traceable decisions. VativoRx builds all three in by default.

Documented Validation Logic

Criteria applied to each claim are defined before the review begins and available for review at any time — organized to answer questions, not reconstruct answers.

Consistent Methodology

The same framework is applied across every claim, every cycle. Inconsistency in exclusion logic is one of the most common sources of compliance exposure.

Claim-Level Audit Trail

Every eligibility determination is logged at the individual claim level. The record exists before anyone asks for it, structured to answer the question when it comes.

Security

Data Security & Handling Standards

Data exchanged as part of the VativoRx engagement is transmitted via encrypted secure file transfer — HIPAA and HITECH aligned. No PHI is required for initial analysis.

Encrypted File Transfer

Secure SFTP for all data exchange — at rest and in transit. No unencrypted transfers at any stage of the engagement.

HIPAA-Aligned Process

Data handling reviewed against HIPAA requirements at every stage. Protocols are documented and available for client review.

No PHI for Initial Analysis

Engagement scoping and Phase 1 review require no patient-level data. Analysis is performed at the claim-type and program level only.

HITECH-Aligned

Security protocols aligned to HITECH standards for electronic health information handling and breach notification requirements.

Security Assessment Ready

VativoRx consistently passes the technical and security assessments required by hospital and health system clients before an engagement begins.