Prescriber Eligibility
An environment of zero tolerance requires immediate risk mitigation.
Many of the healthcare industry’s most pressing compliance challenges converge at the pharmacy dispensing process. Mistakes made in a split second can unwittingly abet fraud, waste and abuse (FWA) and pose the threat of significant financial penalties or fines. Prescriber Eligibility is a prescriber verification solution, based on the HMS Provider MasterFile, offering a robust data checking engine, preconfigured best practices, audit support, dashboard reporting,and real-time data refresh so your pharmacy chains mitigate risk across the claims submission lifecycle.
Immediately reduce the risk of processing payments to invalid prescribers.
Checks include:
- State Licensure and Prescriptive Authority
- Controlled Substance Violations
- Deceased Doctors
- State Medicaid and Federal OIG Exclusions
- Invalid Prescriber IDs
Reduce your go-forward risk of state, federal, and third party payer non-compliance
- Identify areas of non-compliance based upon a particular state’s dispensing and claims submission requirements
- Determine annual financial impact of non-compliant claims submissions
- Identify the potential for audit and possible FWA by geographic area and/or a particular provider
- Make intelligent business decisions such as determining how to reduce claim submission non-compliance and reclaiming FWA funds
- Identify areas where there are data challenges