Humana Steps Up Audits of Pharmacy Claims, Requires Pedigree Papers
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Humana Steps Up Audits of Pharmacy Claims, Requires Pedigree Papers

Pharma Solutions has learned that starting at least in May 2017, Humana retained the services of Conduent Payment Integrity Solutions to start “Invoice Auditing” retail pharmacies.

Humana joins OptumRX (through their VAWD requirement) and CVS Caremark in stepping up their investigations of retail pharmacy claims – including the requisition of wholesaler data with respective pedigrees/transaction history.

Conduent (on behalf of Humana) requested “all pedigree papers and summarized reports of purchases, and any records by all means of transfer for the drug products” as a part of their Invoice audit. Conduent requires that wholesalers provide this information to them directly via email.

Additionally, Conduent requests that they receive the name, and the respective account representative, of each wholesaler used in the invoice audit time period.
They finished the request with a thinly veiled threat stating that if a pharmacy fails to comply with the demands, they could be removed from the network and then face a five-year waiting period before being allowed back into the network. As the industry continues to change on a day-to-day basis, Pharma Solutions does its best to provide up-to-date information – as always, please free to reach out to us if we can help in any way. We look forward to working with you.

About Pharma Solutions

Pharma Solutions is a leading pharmaceutical compliance services firm that uses experience, relationships and knowledge to develop custom solutions for their clients. The company provides numerous services including VAWD Accreditation, state Board licensing and federal registration. Five Rivers helps third-party logistic firms, distributors and manufacturers in the pharmaceutical industry focus on their supply chain while reducing costs, enhancing efficiency and improving quality. Five Rivers is committed to helping their clients thrive and to providing peace of mind.

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