Every so often, the prices for a new prescription medicine make the news because of exorbitant prices. But people in the trenches paying health plan pharmacy claims know high prices are the rule, not the exception. Therefore, routinely planning an Rx audit is wise to double-check all payments for accuracy. There are also the promised discounts and rebates – and confirming they have been made is wise. The oversight function that auditing provides and the added perspective it gives management is always valuable. It's part of fiduciary best practices and a long-term cost containment strategy.
When claims auditors take setup seriously, they carefully include every detail of your plan's Rx formulary in their systems. Combined with general audit experience and an understanding of where things can fall through the cracks, it produces an audit of impressive accuracy. Thanks to today's technology and more advanced systems, every claim paid can be reviewed, and the electronic check turns up more details. Things that would be overlooked during the former random sample auditing are now detected instantly and cover every claim. It's made the value of claim audits increase hugely.
Each year, as new medicines are introduced, others go off patent, and generics become available, the landscape changes. When the changes occur, payments for dispensing must be shifted promptly to take advantage of savings. Auditors can report whether pharmacy benefit managers are on time with the updates. It also points out the value of continuously monitoring claims and having real-time data. When you have quality oversight, it's easier to stay on top of managing changes as they occur. With the expense of new medicines, generics must be dispensed as soon as available.
Implementation auditing also plays a role in accuracy in Rx claim auditing. Large PBMs handle multiple plans; ensuring yours is set up correctly in their system is vital. Oversight nearly always plays a role in accuracy gains. Even when error rates are naturally in the low single digits, the sums add to material amounts over time. It also has a beneficial effect on dispensers when they know self-funded plans are double-checking their work. If you let errors go, it's an indirect incentive for more to happen. When you catch everything in its early stages, you avoid ending up with a million-dollar problem.
Company Name- TFG Partners, LLC
Address- 437 Grant St #1020, Pittsburgh, PA 15219
Contact Number:(412)-281-2228
