Price Validation
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How do you know if you are charged the correct price?
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Do you know the current rates? What are Per diems, AWP, FUL, WAC and MAC.
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Adjudication
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There are both advantages and disadvantages to adjudication
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Advantages:
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Price Validation at time of fulfillment
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Basic cost control mythologies can be implemented prior to pharmacy dispensing
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Every billing line can be validated quickly in real time
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Disadvantages:
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Many contracts are written without thought as to how the pharmacy billing system can bill accurately and allow validation by adjudication. This leads to a change of standard operating procedures which has its own problems. Any time you change the normal process this in itself can lead to billing errors.
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Adjudication has its own costs
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Sometimes adjudication reduces the reporting capabilities of the pharmacy system
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Pharmacies can circumvent the adjudication process.
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The pharmacy can change the price to print on the invoice after the adjudication process
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