Price Validation
-
How do you know if you are charged the correct price?
-
Do you know the current rates? What are Per diems, AWP, FUL, WAC and MAC.
-
Adjudication
-
There are both advantages and disadvantages to adjudication
-
Advantages:
-
Price Validation at time of fulfillment
-
Basic cost control mythologies can be implemented prior to pharmacy dispensing
-
Every billing line can be validated quickly in real time
-
-
Disadvantages:
-
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.
-
Adjudication has its own costs
-
Sometimes adjudication reduces the reporting capabilities of the pharmacy system
-
Pharmacies can circumvent the adjudication process.
-
The pharmacy can change the price to print on the invoice after the adjudication process
-
-
-
