Avoiding Humana Audits for Deceased Patients
Humana has recently sent out another round of audits to pharmacies with the subject line: Review of claim(s) billed after member’s deceased date.
Entries by Jennifer Ottman, CPhT
A Documentation Checklist for Continuous Glucose Monitor Claims
For any item to be covered by Medicare B, there must be clinical documentation to support the covered diagnosis, prove it is reasonable and necessary for treatment and meet all other Medicare requirements.
Be On the Lookout for Prescription Reversal Requests from Humana
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.
Levemir® FlexPen® is Replacing the Levemir® FlexTouch®
Novo Nordisk® discontinued manufacturing the Levemir® FlexTouch® in early February 2023.
Are Your Delivery/Signature Logs PBM Compliant for 2023?
A common component of a pharmacy audit request is the delivery/signature log.
PBM Prescription Validation Requests Rose Nearly 20% in 2022!
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…
Beware: Caremark is Monitoring High Quantity Utilization and Atypical Dispensing Habits
Beyond traditional desktop, on-site, investigational or invoice audits, Caremark performs various compliance reviews.
Update: Medicare Part D Mandatory E-Prescribing Requirements for Controlled Substances – Final Rule
PAAS National® alerted pharmacies to the delay in enforcement of Electronic Prescribing for Controlled Substances (EPCS) for Medicare Part D until January 1, 2023.
DMEPOS Mini-Series #8 – The Six Medicare Auditing Entities and Their Purpose
The six Medicare auditing entities are responsible for auditing records, claims and payments. What is the rationale for having these auditing entities?
Be on the Lookout for OptumRx Unannounced Onsite Audits
Being prepared for an unannounced audit is crucial and PAAS National® wants to make sure you have the tools to be successful.
