Rx Quality Claims, LLC
The right presciption for controlled pharmacy expense!
Why conduct a pharmacy audit?
· Control wasteful spending – between 3% and 10% of all claims processed are inaccurate.
· During economic hard times, many organizations want to retrieve overpaid claims to the maximum extent possible.
· New plan or changes to a current plan – if you have made changes to a current plan or have a new plan, you want to make sure these changes are being implemented correctly.
· Peace of mind in knowing your pharmacy benefit is being administered the way you intended it to be administered.
· Add money from unauthorized claims back to your bottom line for other more necessary and needed expenses.
When should you conduct a pharmacy audit?
· You should conduct an audit immediately. The longer you wait the harder it is to recoup money for incorrectly processed claims.
· Many experts agree that you should do an audit after one year of a signed contract and annually thereafter.
· If your Pharmacy Benefit Manager has just merged with another Pharmacy Benefit Manager, you should do an audit.
· If you have recently changed your benefit, you should do an audit.
· If your pharmacy benefit is trending unusually high, you should do an audit.
