Pharmacy Claim Verification
Ensuring accuracy and compliance through thorough onsite and desk audits of prescription claims.
Pharmacy Claim Verification
Ensure accuracy, protect revenue, and maintain compliance with our comprehensive prescription claims validation audits. Whether conducted on-site at your pharmacy or remotely via a desk audit, these reviews compare original prescription documentation (hard copies) to submitted claims data (e.g., Excel reports, pharmacy system exports) to confirm the integrity and accuracy of every claim.
Onsite Claims Verification Audit
Thorough evaluation of prescription records against claims data for accuracy and compliance. Also known as Source Documentation Review, payers or PBMS
Desk (to-Source) Verification Audits
Conducting detailed audits remotely to identify prescription accuracy, billing errors, overbilling and ensure regulatory adherence.
Pharmacy Claim Verification FAQs
What is claim verification?
Claim verification ensures prescription records match claims data for accuracy and compliance. Confirms that drug name, quantity, days supply, prescriber details, and other claim elements match the original prescription.
How are audits conducted?
Audits can be performed onsite or as desk audits, depending on the needs of the pharmacy.
Why is this important?
This process helps detect billing errors, fraud, and ensures adherence to regulatory standards set by PBMs, state board and DEA.
Who conducts these audits?
Qualified professionals with expertise in pharmacy operations conduct these audits.
What are desk audits?
Payers and PBMs routinely conduct these audits to detect billing errors, overpayments, or non-compliance.
How often should audits occur?
Regular audits are recommended to maintain compliance and identify potential issues proactively.
Contact Us
Get in touch for pharmacy claim verification services.