Comprehensive financial and clinical auditing
Financial Claim Audit
Financial Claim Audit
Financial Claim Audit
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
Financial Claim Audit
Financial Claim Audit
Prior Authorization, Step Therapies, Quantity Limits
Retrospective drug utilization review
Specialty drug programs
Patient adherence programs
Pharmaceutical Rebate Contract Validation and Reconciliation
Pharmaceutical Rebate Contract Validation and Reconciliation
Pharmaceutical Rebate Contract Validation and Reconciliation
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
Pharmaceutical Rebate Contract Validation and Reconciliation
Pharmaceutical Rebate Contract Validation and Reconciliation
100% of audit clients realize contractual term improvements in additional to monetary recoveries