Progressive Healthcare Solutions offers these tips when preparing for a PBM (Pharmacy Benefit Manager) audit. For more information on these tips, expert training, and more, please contact Progressive Healthcare Solutions today! To help avoid penalties and fines during a PBM audit:

  1. Review PBM Contract: Review the PBM contract to understand the terms and conditions of the agreement. Ensure that the pharmacy is meeting all of the requirements and obligations set forth in the contract.
  2. Review Claims and Record-keeping: Ensure that all claims are accurate and complete. Review records to ensure they are up-to-date and compliant with HIPAA regulations. It is important to have detailed records of prescriptions, refills, and dispensing information.
  3. Review Documentation: Ensure that all documentation related to prescriptions, including prior authorization requests, is complete and accurate. Documentation should include information such as the prescriber’s name, date of prescription, and drug name, strength, and quantity.
  4. Staff Training: Train pharmacy staff on how to handle a PBM audit. Staff should be aware of the PBM contract terms and conditions, as well as the pharmacy’s policies and procedures. Staff should be familiar with HIPAA regulations and ensure that all documentation is in compliance.
  5. Conduct Self-Audit: Conduct a self-audit of the pharmacy’s practices to identify any areas of non-compliance. Address any issues found in the self-audit to ensure that the pharmacy is fully compliant.
  6. Maintain Communication: Maintain communication with the PBM and stay updated on any changes in regulations or policies. This will help the pharmacy stay informed and prepared for any upcoming audits.

By following these steps, a pharmacy can be well-prepared for a PBM audit and ensure that it is in compliance with all regulations and contractual obligations. Progressive Healthcare Solutions experts can guide you through these steps and help ensure a successful audit. Contact us today!

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