Community pharmacies are constantly seeking ways to minimize the costly impact of potential third-party audits, as there are numerous pharmacy claims audit triggers that are regularly monitored by these third parties to help manage costs and reduce fraud, waste and abuse for health plans.

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Your pharmacy may find itself at risk for a third-party audit sometime this year, if not a handful of times. These audits can be very costly financially, with the average pharmacy audit loss in the thousands of dollars per year, but they can also be costly in terms of time and resources. Your pharmacy staff may spend several hours preparing for each one—a significant cost for something that does not help your business grow.

Protect your community pharmacy from common pharmacy claims audit triggers

Our RelayRx™ Claim Audit and Risk Evaluator (RelayRx™ CARE) program offers several services that can help protect community pharmacies from audit-triggering pharmacy claims transactions at the point of dispense - helping to proactively mitigate audit risk and save your pharmacy valuable time and money. RelayHealth also offers improved efficiency and protection against profit loss through our innovative community pharmacy reimbursement performance solutions. We work hard to protect your pharmacy so that you can focus on what's most important to you—your patients.

Features of RelayRx Claim Audit and Risk Evaluator:
  • In-workflow solutions for immediate action at the point of dispense
  • Seamlessly works with all pharmacy systems
  • Messaging to pharmacy staff to correct or validate potential audit triggers before pharmacy claim is paid
We can help:

¹2013 OIG Special Advisory Bulletin: Effect of Exclusion from Participation in Federal Health Care Programs