RelayRx CARE: Pharmacy Audit & Risk Mitigation

Avoid audit-triggering claims transactions with RelayHealth’s audit-risk reducing solution for independent community pharmacies.

Your community pharmacy may find itself at risk for a third-party audit several times in a single year. Each audit can cost thousands of dollars—not counting the expense of lost time and resources.

Third-party audits have many triggers to help reduce fraud and abuse, so community pharmacies must find ways to minimize the impact of potential audits. RelayRx™ Claim Audit and Risk Evaluator (RelayRx™ CARE) protects community pharmacies from audit-triggering pharmacy claims transactions at the point of prescription drug dispense.

Protect your community pharmacy from common pharmacy claims audit triggers

RelayRx CARE reduces your audit risk, saving you valuable time and money. Our community pharmacy reimbursement performance solutions offer improved efficiency and protection against profit loss so you can focus on patient care and outcomes.

RelayRx Claim Audit and Risk Evaluator can help you:

  • Address “Plan Limits Exceeded” (example: for insulin), a top reason for pharmacy audits
  • Reduce your Office of Inspector General (OIG) audit risk (associated with dispensing prescriptions written by an excluded prescriber) to save yourself a $10,000 fine plus three times the claimed amount for each audited instance¹
  • Check prescribers’ writing authority for controlled substances

RelayRx Claim Audit and Risk Evaluator features include:

  • In-workflow solutions for immediate action at the point of dispense for independent pharmacies
  • Seamless interaction with all pharmacy systems
  • Messaging to pharmacy staff to correct or validate potential audit triggers before pharmacy claim is paid

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

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