Pharmacy Claims Audit Services


As a Plan Sponsor, there are many reasons for you to audit pharmacy claims beyond your fiduciary responsibility to proactively manage costs for stakeholders. Perhaps you are changing vendors, implementing new benefit designs, or offering a wide range of options for members. All of these complex situations can increase the likelihood of payment errors. Many companies are also becoming affected by regulations that require that their oversight include adequate auditing and accounting.

No matter what their business motivation, Caribou has provided comprehensive pharmacy claims audit services – including manufacturer rebate contract auditing – to companies of all sizes in almost every industry.

Powered By Expertise and CaribouRx
Caribou’s background in claims processing systems provides us with a keen understanding of the complexities of pharmacy claims. Our expertise has allowed us to develop sophisticated methodologies and a robust, scalable technology platform that can audit millions of claims accurately. CaribouRx (CRx) is a robust re-adjudication system that accommodates the extensive contract and benefit plan variables that exist in the marketplace today. CRx can perform rigorous testing of new system functionality, which provides our auditors with a dependable platform with repeatable, reliable results.

Serving Plan Sponsors and Major Payers Nationwide
Plan Sponsors and Major Payers have relied on Caribou’s pharmacy claim audit services for years. They count on our staff’s decades of experience in pharmacy benefits, and the unparalleled value and service that we deliver. Most importantly, they know that we provide them with completely reliable and objective information because we are an independent company, with no affiliation of any kind to any PBM.

THE ADVANTAGE OF CRX Our pharmacy auditing system, CRx, enables our team of Pharmacy Claim Auditors to expedite the completion of detailed audits for even the highest volume clients. Advantage of CRX Overview Audit Process Overview EXPERIENCE MATTERS Our team represents decades of experience in pharmacy benefits and we audit over 100 million claims per year. This extensive experience has allowed us to develop a thoroughly robust product that makes a difference to our clients. For more information about how we can help your organization, CONTACT US TODAY!