The primary goal of the PBM Audit is to uncover discrepant claims and recoup money paid to your pharmacy. What most pharmacies do not realize is that even minor audit findings can result in network terminations. All adjudicated claims are subject to audit regardless of the fact the claim paid. Boesen & Snow offers proactive advice and solutions to help you mitigate the risks PBM audits present. PBM provider manuals include hundreds of pages of hidden traps waiting to trip you up and justify aggressive PBM action. If your Pharmacy has been notified of an audit, contact our experienced PBM audit defense team. Please click the box below, your responses will be immediately sent to our PBM Audit Specialist.
The key points in mitigating PBM audit findings include:
PBM Auditors wield the power of one-sided provider agreements, unlimited resources, and unforgiving auditors. Every step of the PBM audit is an opportunity to identify a missing process, data point, or document that can justify harsh contractual punishments. Everything you say and every document you provide can be used against you in unforeseen ways.
Your Boesen & Snow audit team will include a pharmacist, an attorney, and a former PBM lead auditor who know the process inside and out. They can help your business respond to desktop and onsite audits to achieve the best results the first time. There is no “routine” audit that a non-attorney consult or inexperienced law firm can handle. The point of the audit is to find discrepancies and take your money. Do not trust your business with advisors who do not understand the danger lurking in every PBM audit.
PBM Audits are a reality all pharmacies face—it is not a matter of if but when. Proactive measures include Pharmacy Operations review, developing Policies and Procedures and corrective actions, staff training, continuing compliance review. When audits come, Boesen & Snow can help with organized, accurate, and timely responses. Prevent the need to hire Boesen & Snow to appeal negative audit findings by engaging the firm before trouble hits.
Fields marked with an * are required