There's a tendency among employer-funded benefits plans to audit medical claims but experts in the field remind you not to overlook an Rx audit. Pharmacy claims have different criteria, but the numbers are large, and mistakes are costly. Promised discounts might often not be applied, or name-brand medications are prescribed when lower-cost generics are available. Your pharmacy benefit manager should be watching, but no one is perfect, and errors happen. With today's advanced audits that review every claim, unlike the old random samples, you'll be impressed by the reports you'll receive.
Pharmacy benefits managers (PBMs) make performance guarantees and self-report on their work. But careful plan managers know oversight is crucial and gives an independent analysis of claim payment activity. It's become so important that many self-funded plans have their claims monitored continuously by auditors. It's the best way to keep verifying plan performance and trends in utilization and costs. Today's electronic portion of a claim review gets closer to the finish line than ever, and less human involvement is required. At the same time, accuracy is better than ever, and the reports are detailed.
Properly auditing pharmacy benefit plans requires unique expertise. Understanding formularies and the complex discount and rebate schemes manufacturers offer is essential. It draws on the full range of audit skills with extra considerations. When working with a firm specializing in the field, you'll get the most from an audit. They'll want to understand the unique provisions of your plan but can also apply their knowledge from other similar audits. It's a given that the costs go up every year, and the claims become more complex. What may sound straightforward isn't always when it's completed.
Many employer-funded plans audit pharmacy claims concurrently with their medical plan audits. It's a way to scrutinize and manage costs across the largest parts of the healthcare benefits offering. Today, it's routine for audits to pay back more than four times their price in identified savings and provide you with an excellent plan management tool. Even if your PBM contract includes performance guarantees, audit to ensure they're being honest – and a good auditor may uncover mistakes the processor has not detected proactively. The independence of specialist auditors and their systems is an asset.
Company Name- TFG Partners
Address- 437 Grant St #1020, Pittsburgh, PA 15219
Contact Number: (412)-281-2228
