Post-Implementation Audits

Solutions

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:

CARIBOU POST-IMPLEMENTATION AUDIT ADVANTAGES

  • Our extensive background in quality assurance and pharmacy claim processing creates a rigorous process that identifies implementation errors in a timely manner.
  • Our audit staff can recognize error trends and PBM processing weaknesses or gaps against industry standards.
  • Our knowledge of PBM standards allows us to identify areas where claim processing is set up based on PBM defaults instead of per client intent, resulting in inconsistencies in claim payments across plans for the same client.

For more information about how we can help your organization,
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