RxProtect: Audit Protection

Safeguard Your Investment

As a pharmacy owner, you’re acutely aware pharmacy benefit managers (PBMs) can audit your pharmacy at any time. But are you prepared for an audit? Are you demonstrating proper pharmacy compliance? Are your processes and operations at the level they should be?

Through RxProtect, AlignRx provides comprehensive audit services designed not only to identify and reduce your audit risk, but also to diminish the impact of unjustified recoupments.

Our RxProtect team comprises Certified Pharmacy Technicians who possess the skills and clinical know-how to ensure your audit runs smoothly. We thoroughly analyze your claims data and study your pharmacy operations at a granular level, leaving nothing to chance. Our mission is protecting your bottom line.

 

Audit and Appeal Preparation

Audit and appeal preparation demands considerable time, which you don’t always have given your commitment to patient care. Our experienced team leads you through the audit process from start to finish. We rigorously check key aspects for compliance with state, federal and PBM requirements. We analyze discrepancy reports, review responses, and instruct you on appeals to prevent audit recovery or termination.

Our preparation process is all-encompassing—we essentially conduct a mock audit of your pharmacy to pinpoint and resolve potential issues before your actual audit takes place. For those pharmacies we have assisted in the audit process, eighty percent have resulted in zero dollars in recovery.

 

Audit Services

  • Audit Training
    AlignRx offers comprehensive training materials so you can train your pharmacy staff with helpful information regarding network compliance and operational procedures, such as PBM requirements related to filling and billing prescriptions. Our team is also available to train your staff on your behalf through a live webinar. Our goal is to incorporate audit prevention strategies into your pharmacy workflow.
  • On-Site Audit Participation
    For an additional fee, AlignRx travels to your location to assist your pharmacy in an audit. Whether you’re short-staffed or prefer the experience of an objective party, you can count on us to respond to PBM inquiries on your behalf.

 

Resources and Guidance

AlignRx provides a variety of tools to you and your staff to ensure network compliance and sound operational procedures.

  • Hard copy documentation requirements review covers policies, procedures, invoices, and logs, such as signature and controlled substances logs.
  • Billing reference guides help prevent your team from making mistakes when filling prescriptions.
  • Customized, proactive weekly reports identify high-risk audit items that may be a red flag for PBMs.
  • Quarterly newsletters include audit tactics, tips, and industry highlights to keep you informed.

More Services

Compliance Guardian

ClaimGuard

Payor Contracting

eRecon Claims Reconciliation

Direct Contract Consulting

RxProtect Audit Protection

Clinical Connection

Central Pay

Clinical Services