You have no items in your shopping cart.
Financial, Performance & Claims Audit
PRO PHARMA's Consulting Services include benefit auditing and management; performance reviews; negotiations with plans, PBMs and providers; and the development and implementation of cost reduction programs. We are pleased to present our Audit Service Portfolio below for your review:
Financial & Performance Audits
- Detailed Financial Analysis of Pharmacy and Medical Encounter Claims
- Eligibility Audit
- Audit of Claims for Validity, Pricing, AWP, etc.
- Rule-Based Benefit Simulation of Benefit Design
- Financial Drivers of the Benefit
- Questionable/Abuse Audits
- Reconciliation
- MMA Part D
Rebate Analysis
- Baseline Audit of Rebate Claims
- Benefit Design Scenarios vs. Impact on Rebate/ Net Cost Optimization
- Net Cost vs. Rebate Optimization Modeling
- PBM / Manufacturer Contract Review (if available and applicable)
- Drug Utilization Review Audits
- Coordination of Benefits
Audits Include BUT ARE NOT LIMITED TO:
- Financial
- Performance
- Rebate Analysis
- Drug utilization Review
- Coordination of Benefits
Pro Pharma's Consulting Services include benefit auditing and management; perfor-mance reviews; negotiations with plans, PBMs and providers; and the development and implementation of cost reduction programs. We are pleased to present our Audit Service Portfolio below for your review:
The Financial, Performance & Claims Audits Utilizes:
- Fraud, Waste & Abuse
- Continuous Monitoring Of FWA Targeted To Prevention And Modification Of Performance
- Invoice Screening
- Monthly Management Analyses Of Integrated Data Sets To Identify Outliers For Targeted Improvement
- JCode Calculator
- Specialty Medication Fee Schedule With Approved Diagnoses And Quantities
- Market Share Analyses
- Cost Accounting Of Every Dollar Spent Including Discounting And Utilization
- Prior Authorization
- Compliance With FDA Approved Indications And Usage
- Retrospective Audit
- 100% Digital Audits Of Data Sets To Identify Compliance With Contracts And Benefits
- Trend Managment & Disease Map
- Oversight Of Financial Trend And Clinical Usage
Featured products
Invoice Screening
Analyses and audits of pharmacy invoices to identify, prioritize and manage problems with claim adjudication.
Call for pricing
Market Share Analyses
Cost accounting for every dollar spent on pharmacy including actual spend, number of patients and Rx, and an exhaustive list of metrics for budgeting.
$0.00
Prior Authorization
Specialty Pharmacy and Medical benefit Medication Prior Authorization (PA) criteria that is fully automated, digital, web-based, and includes effectiveness (ICD10), risk (FDA Alerts), utilization, genomic testing, step-therapy, cost, and options for care.
Call for pricing
Request for Proposal Management
Fully automated, digital, customizable, searchable, document linked, web-based program to allow for rapid and efficient evaluation of vendor proposals.
Call for pricing
Retrospective Audit
Exhaustive, digital and fully automated Auditing/Analyses of pharmacy claims experience to use for audit requirements and management prioritizing for corrective actions.
$0.00
