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Comprehensive Audit and Recovery: Ensuring Accuracy and Savings
Our Process
Our Audit and Recovery service follows a three-step approach to ensure you’re only paying for the benefits you intend to provide. First, through a Financial Audit, we use our proprietary system to electronically review every component of your pricing, including Average Wholesale Price (AWP), Maximum Allowable Cost (MAC), Non-MAC’d Generic, Dispensing Fees, and Lesser of Logic. We also validate several unique, proprietary elements, providing you with a detailed report and clear insights into how these factors impact your plan.
Next, our Administrative Audit ensures your plan design is programmed accurately. We review covered and non-covered drugs, age limits, prior authorizations, and quantity limits, identifying any inconsistencies and their associated costs. Finally, with our Rebate Audit, we verify the accuracy of rebate calculations by analyzing claim data and comparing it to PBM contracts. Working under non-disclosure agreements when needed, we provide a confidential yet thorough assessment, helping you recover funds and optimize your plan’s performance.
Three Steps to Optimize Your Plan and Maximize Savings
Step 1: Financial Accuracy Audit
The HealthLinX (HLX) proprietary system performs a 100% electronic review of every component of your pricing, including:
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Average Wholesale Price (AWP)
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Maximum Allowable Cost (MAC)
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Non-MAC’d Generics
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Dispensing Fees
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Lesser of Logic
Our system also validates several unique, proprietary elements. We will review all these components and provide a detailed report explaining their impact on your plan.
Step 2: Administrative Plan Audit
The Administrative Audit reviews the accuracy of your plan's design and programming. We examine several areas for accuracy, including:
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Covered and non-covered drugs
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Age limitations
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Prior authorizations
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Quantity limits
Our process also includes a review of several other factors proprietary to the HLX system. Once complete, we provide you with an assessment of your plan's setup and detail the cost of any inconsistencies we find.
Step 3: Rebate Integrity Review
The HealthLinX (HLX) Rebate Audit uses a proprietary system to ensure the accuracy of your rebate administration. We provide a thorough, confidential assessment that helps you recover funds and optimize performance.
Our process includes:
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Data Analysis: We review your plan's claim data to verify rebate calculations.
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Contract Comparison: We compare the data against your highly protected PBM contracts to identify discrepancies.
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Confidential Auditing: We often work under non-disclosure agreements with the PBM to audit and measure performance, keeping sensitive manufacturer agreements confidential while reporting all findings back to you.