Plan Sponsors have many reasons to audit pharmacy claims beyond the fiduciary responsibility to proactively manage costs for stakeholders. Perhaps they 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 affected by regulations requiring oversight that includes adequate auditing and accounting.
No matter what their business motivation is, Caribou has provided comprehensive pharmacy claims audit services – including manufacturer rebate contract auditing – for companies of all sizes in almost every industry.
- Pre-Implementation Audits
- Post-Implementation Audits
- Plan Benefit Audits
- Financial Audits
- Rebate Audits
Powered By Expertise and CaribouRx
Our expertise has allowed us to develop sophisticated methodologies and a 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. We perform rigorous testing of new system functionality, which provides our auditors with a dependable platform and repeatable, reliable results.
Serving Brokers/Consultants, Plan Sponsors and Major Payers Nationwide
Auditing PBM claims is a critical component to controlling pharmacy costs. If you are a broker/consultant advising employers on their benefits, Caribou is the ideal partner as we do not provide any benefit consulting services. Clients 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.