AUDIT AND RECOVERY

Three step approach to ensuring you are paying only for the benefits you intend to provide

FINANCIAL AUDIT

HealthLinX (HLX) proprietary system provides a 100% electronic review for each component of your pricing including:

  • Average Wholesale Price (AWP)

  • Maximum Allowable Cost (MAC)

  • Non-MAC’d Generic

  • Dispensing Fee

  • Lesser of Logic

 

There are several other components that HLX validates which are unique and proprietary to our system.  All of these components will be reviewed and reported to you with interpretation of the impact to your plan.

ADMINISTRATIVE AUDIT

The Administrative Audit reviews the accuracy of the plan design programming of your plan.  Covered drugs, non-covered drugs, age limitations, prior authorizations and quantity limits are all reviewed for accuracy as well as several other areas which are proprietary to the HLX system.  When HLX completes the administrative review, you will be provided with an assessment of the accuracy of your plan set-up and the cost of any inconsistencies. 

REBATE AUDIT

HLX uses a proprietary audit system to review the rebates our plans receive.  Most plans require a calculation based upon the greater of a guarantee or a percentage of the net rebate.  How do you know if the net rebate is calculated correctly for your plan?  HLX provides a look into the accuracy of t the rebate administration by reviewing the claim data, comparing the information to the highly protected PBM contracts and reporting the findings back to the plan.  Because of contractual agreements with the manufacturers, HLX often works under a non-disclosure agreement with the PBM to audit and measure performance without revealing detail to the plan, keeping their manufacturer agreements confidential.