Comprehensive financial and clinical auditing

Financial Claim Audit

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Contract compliance (pass through, traditional and rebate reinvestment models)

Adjudication accuracy

Concurrent drug utilization review performance

Co-insurance and mapping of deductible and OOP max amounts

Clinical Services

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Prior Authorization, Step Therapies, Quantity Limits

Retrospective drug utilization review

Specialty drug programs

Patient adherence programs

Pharmaceutical Rebate Contract Validation and Reconciliation

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Reconciliation to invoice credits

Performance guarantees

Customer service call center reviews including mail order and specialty pharmacy

Call resolution and escalation process

Pharmacy pass through contracts at retail and specialty

Results

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100% of audit clients realize contractual term improvements in additional to monetary recoveries