Humana periodically performs retrospective claim reviews. If upon review Humana determines a claim was billed in error (i.e., after the Humana coverage was terminated), the pharmacy will get a prescription reversal letter.
Novo Nordisk® discontinued manufacturing the Levemir® FlexTouch® in early February 2023.
A common component of a pharmacy audit request is the delivery/signature log.
Prescription Validation Requests (also known as claim reviews) are becoming a more frequent occurrence with many PBMs. In 2022, PAAS saw an 18% increase year over year. Some of the reasons these claims get flagged include…
Beyond traditional desktop, on-site, investigational or invoice audits, Caremark performs various compliance reviews.
PAAS National® alerted pharmacies to the delay in enforcement of Electronic Prescribing for Controlled Substances (EPCS) for Medicare Part D until January 1, 2023.
The six Medicare auditing entities are responsible for auditing records, claims and payments. What is the rationale for having these auditing entities?
Being prepared for an unannounced audit is crucial and PAAS National® wants to make sure you have the tools to be successful.
PAAS would like to point out some of the updates and additions to section 11.15 of the document Billing of a Self-Administered Free COVID-19 Oral Antiviral During an Emergency.
This month, we continue with our DMEPOS mini-series by discussing yet another challenging category – immunosuppressive drugs for a transplant. Immunosuppressive drugs are only covered under Part B to maintain an organ transplant that was Medicare eligible.
