Preparing for Onsite Audit Success

Since the expiration of the COVID-19 Public Health Emergency in May 2023, PAAS National® has seen a significant increase in on-site audit notices from PBMs across the board. We have tools to help reduce stress and prepare your pharmacy for success ahead of the audit. Be sure to call PAAS promptly to open a case and send in your audit notice as soon as possible. We also recommend reviewing How to Be Prepared for an Onsite Audit under “Proactive Tips” on the Member Portal. Once your case is opened, an analyst will reach out to discuss the details. If you have specific questions about the audit, have them ready—our goal is to support you and help you succeed!

PAAS Tips:

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  • Send the complete audit notice and any masked or unmasked list to PAAS when received
    • If you receive a prescription list (masked or unmasked), talk with your analyst before sending any prescriptions for review
  • The FWA/HIPAA Compliance Program through PAAS National® has many of the tools needed for the auditor to review during the onsite visit:
    • Access to required FWA/HIPAA training
    • OIG/GSA exclusion checks (done daily)
    • Detailed Policy & Procedure manual (includes policies for partial fills, copay collection, CMS-10882 and 10147, patient demographics, etc)
  • Auditors will typically leave an exit summary, which should be looked over carefully. Be sure to ask the auditor when you can expect to see the results.
  • Review the Onsite Credentialing Guidelines for an overview of the compliance questions you should be prepared for during the onsite audit
  • The Self-Audit Series has in-depth details of different types of prescriptions that have been targeted by PBM audits and recoupments

Erin McDonald, PharmD
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