Financial, Performance & Claims Audits™
PRO PHARMA's Consulting Services include benefit auditing and management; performance reviews; negotiations with plans, PBMs and providers; and the development and implementation of Disease State Management Programs. We are pleased to present our Audit Service Portfolio below for your review:
FINANCIAL & PERFORMANCE AUDITS
- Detailed Financial Analysis of Pharmacy and Medical Encounter Claims
- Eligibility Audit
- Audit of Claims for Validity, Pricing, AWP, etc.
- Rule-Based Benefit Simulation of Benefit Design
- Financial Drivers of the Benefit
- Questionable/Abuse Audits
- Reconciliation
- MMA Part D
REBATE ANALYSIS
- Baseline Audit of Rebate Claims
- Benefit Design Scenarios vs. Impact on Rebate/Net Cost Optimization
- Net Cost vs. Rebate Optimization Modeling
- PBM / Manufacturer Contract Review (If available and applicable)
DUR (DRUG UTILIZATION REVIEW) AUDITS
- Provider Audit
- Drug Frequency Cost Audits
- Disease Frequency/Trends
- Technology Assessment/Impact
COB (COORDINATION OF BENEFITS)
- Third Party
- Workers Compensation
- Benefit Exclusions
For more information about these services or applicable rates
in your service area,
please contact Carol Stern @ 818-701-5438 or carol.stern@propharmaconsultants.com
 |
 |