Of all types of PBM audit types, the most concerning ones are invoice shortage audits. PBMs and governmental programs treat invoice shortages as telltale signs of fraud and abuse. Countless pharmacies have lost their PBM contracts as a result of audit shortages findings. Adverse findings also result in payment holds, withholdings, terminations from PSAOs, and in some cases, criminal prosecutions.
AuditPilot is here to prepare pharmacies for invoice shortage audits. By combining our deep understanding of pharmacy practice with using sophisticated analytical tools, we are able to anticipate problems and highlight them so that pharmacy owners can act upon them before audits happen.
Claims Data Processing – claim records are continuously collected and categorized
Purchase Records Processing – all purchase records are collected, processed, converted and normalized
Reconciliation & Analytics – using our unique coding databases and artificial intelligence tools, we reconcile purchase and claims records and analyze your data monthly to spot inconsistencies and areas of concern
Results Delivery & Summary – we deliver our findings to decision makers in an easy, relevant format, highlighting our recommendations and areas of concern that make audit preparedness and compliance extremely easy to implement
