Our Rx Audit Management solution lets you manage audits from pharmacy payers through a workflow process designed to:
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Clients are reporting a 200-400% increase in audits
Reduce financial risk, with a 98% audit recovery rate
The first-to-market solution from a reconciliation provider, built on accounting principles
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.
Inmar's RX Audit Management
Quantify Audits
Identify impacted claims
Negotiate and manage take-backs
Provide reports and dashboards with quantitative results, insights into industry benchmarks, and trends
Allow tracking and forecasting of audit activity and carriers’ compliance with contracted audit language
Audit intelligence makes it easy for you to identify which claims are targeted the most so you can implement controls to help prevent future audits.
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