Why Audit My PBM?
If you are wondering if your PBM is processing your claims according to the terms and conditions of the contract or wondering how many of the news releases of PBM lawsuits could affect your situation, you are not alone.
The answer is to allow us to perform an retrospective audit for up to the past 7 years which we address all claims and then compare them to the terms and conditions of your PBM contract. Remember that historically we find the PBM in violation of their agreement 100% of the time.
The result of an audit reveals all facets of the processing of your claims and historically find a sizable amount that has been over charged which is owed back to our client. After the audit we provide detailed hard audit report of all out of compliance claims with reason codes of why each and every claim was processed incorrectly and a soft report of the gray areas that the PBM is fleecing your agreement,
Why PBM Analyzers? PBM Analyzers has a PBM background so we know “where the bones are buried” in PBM contracting and processing. Our program is a proprietary audit system that checks all possible contract elements and data criteria that would have a financial impact. What Happens When I Audit My PBM ? PBM Analyzers will contract on a contingency basis paid a agreed upon percentage of monies identified or if requested on a fee based. This contract also allows HIPAA approved data to be shared with PBM for analysis. We will collect information from your current PBM contract, your intended plan design and your Company eligibility data to set up the audit procedure. From the PBM, we collect the data, the plan “set-up sheet” of the plan design, and the MAC list of generic pricing used and all other data needed. |
