Our Rx Audit Management solution lets you manage audits from pharmacy payers through a workflow process designed to:
The recent evolution of healthcare has resulted in a historically high volume of prescriptions, with a growing portion funded by government payers. This growth has led to increased audit activity and regulatory oversight for fraud, waste and abuse.
What are you experiencing?
- How many audits do you receive? What is the average value?
- How successful are you negotiating reduced recoupments?
- Have you identified any triggers for audits?
- How do you validate take-backs were what you agreed to?
- How much time do you spend managing each audit?
- How successful are you at re-billing to prevent audits or adding more dispensing controls?
- How do you keep audit records? Do you ever have challenges?
The answers to these questions are more important than ever. You need the right tools to manage audits — which can range from a single claim to hundreds of claims — as well as the risk of audit recoupments.
Our easy-to-use Audit Management Web App:
- Increases audit recovery rates to 98% and above with robust data to better negotiate recoupments
- Reduces initial audit exposure and helps prevent future audits with business intelligence
- Improves audit workflow and manages audits from receipt through final recoupment
- Enables faster turnaround times to meet audit requirements
- Provides better validation of agreed upon take-backs with visibility into audit adjustment activity based on tags and claim’s transaction history
- Improves record keeping and reporting to provide audit intelligence
- Improves store compliance with reducing actions that trigger audits