Every claim is reviewed, not a sample. Findings are written in the words your staff already use, with the next step for each.
A few of the checks that run on every claim. Each finding comes with its window and the step to take.
| Item | Where | Status |
|---|---|---|
| Returned to stock, not reversed | Pickup and return | 2 days |
| Days supply mismatch | Billing | 5 days |
| Duplicate fill | Duplicates | Reverse |
| Prior authorization on file | Documentation | Done |
Duplicates, reversals, quantity, days supply and prescription validity.
Early refills and refill patterns that draw attention.
Schedule II rules, early fills and high-risk combinations, flagged for documentation.
Part A stays, hospice and other coverage conflicts.
Facility, Part A and hospice billing for LTC pharmacies.
Programs with special dispensing requirements.
From your pharmacy system's reports.
On every claim.
Most urgent first.
The change to make, and a record once done.
A short screen share with our team. We will walk through the morning list, an underwater claim from appeal to payment, and audit preparation, using sample data.
