Post-Implementation Audits provide plan sponsors and payers with a review of their PBM’s performance as a matter of due diligence. These audits verify correct benefit set up, verify updated financial terms, or can be performed in response to high levels of member complaints. A Post-Implementation Audit will typically include 3-4 months of paid claims after the implementation date. This claim review closely parallels a full claims audit used to measure annual performance, but addresses clients’ concerns related to accurate programming of significant plan changes and member experience.
Options for a Post-Implementation Audit include: