Solutions

Audit protection

Strengthening pharmacies with proactive, protective solutions that help ensure compliance throughout the audit process.

The challenge

Pharmacy audits are costly, time-consuming and can result in significant financial losses. Whether triggered by discrepancies in claims, government regulations or coordination of benefits issues, audits disrupt workflows and put reimbursements at risk. Pharmacies need proactive solutions to maintain compliance and reduce audit exposure before issues arise.

29%+
surge in third-party audits in 2023^[0]
Third-party audits are a routine part of pharmacy and physician dispensary operations but unclear metrics and shifting requirements can threaten business viability.
$23K
average audit cost for pharmacies^[0]
35%
increase of audit costs over five years^[0]

Audit protection benefits

CoverMyMeds offers integrated audit protection solutions designed to help pharmacies reduce common compliance risks before they become audit issues. With automatic validations, real-time alerts and configurable safeguards, pharmacists can proactively address potential audit risks before submission. These solutions work alongside our pre and post claim editing services to enhance claim accuracy, reduce manual interventions and support compliance with payer and regulatory requirements.

Reduce audit risk
Identify and mitigate common compliance issues, and help your pharmacies stay ahead of potential audit triggers.
Support compliance efforts
Smoothly navigate complex payer rules and government plan requirements to help maintain regulatory adherence.
Enhance claim accuracy
Experience real-time validation to help ensure proper claim submission and adherence to industry regulations.
Improve workflow efficiencies
Integrates seamlessly with pharmacy systems to help reduce manual claim corrections and operational disruptions.