A layered approach to PBM audit support for medically integrated dispensing programs
By ION
The most effective way to prevent negative outcomes is to maintain consistent compliance procedures for processing prescriptions. Prevention matters. Standardized direction for use (SIG) codes in pharmacy software, updated electronic health record (HER) drug-therapy protocols, audit checklists for prescription verification, and a second verifier process all help reduce audit risk and strengthen readiness.
Because PBM audits demand precision – matching dispensing workflows to billing activity, generating documentation quickly, and adapting to evolving payer requirements – having an experienced partner can ease the burden on clinical and administrative teams. Cencora offers several tiers of support designed to streamline the audit process, safeguard reimbursement, and reinforce MID program integrity.
Cencora’s integrated model ensures the right level of support based on audit type, payer expectations, and documentation needs, including:
- Pre-audit guidance and preparation – Workflow review and risk mitigation
- Active audit support – Coordination and documentation management
- Claim-level clinical and operational review – Identifying discrepancies before they trigger recoupments
- Appeals and post-audit support – Crafting responses and strengthening future compliance
- On-site and hands-on assistance – Direct support for high-risk or high-volume audits
Whether you’re preparing for your first audit or responding to a multi-claim review, expert guidance can meaningfully reduce risk and workload. The IntrinsiQ Specialty Solutions team recently provided an in-depth overview of PBM auditing best practices as well as an in-depth look at Cencora’s audit services in a webinar that you can view below.
Contact our team at info@intrinsiq.com to learn more about our pharmacy services and solutions — including PBM audit support — and how they can benefit your practice.
