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Desk Audit |
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1.Describe your desk audit program.
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The AudiTrack© program processes pharmacy data for stores that have not reached
a specific claims volume. Proprietary and pre determined edits identify the pharmacies
and specific claims for desk review. The initial investigations are identified through
the results obtained when we submit a client’s claim data to the rigorous system review
using the AudiTrack© application. The Pharmacy Desk Audit Program is utilized in
instances where the system identifies a specific submission or data trend potentially
fraudulent or abusive in nature or where the claim volume of a specific pharmacy is not
sufficient to be included for an on-site audit. Overall, we provide our clients with
approximately 10% to 20 % of the total audits completed as desk audits. History shows
that Desk Audits provide a valuable tool in the identification of obvious submission
errors and can provide a basis for extended or investigational audits.
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Pharm/DUR conducts two types of Desk Audit Programs.
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Desk Audits as a preliminary process to the On Site Audit Program. All On Site audits are
triggered by the AudiTrack© claim review process. This proprietary process essentially
conducts a Desk Audit on every pharmacy.
Desk Audits conducted on pharmacies where claim volume is very low but AudiTrack
has identified inconsistencies with plan parameters or manufacturer guidelines.
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