Billing 301: Third Party Audits

Learn the language of third–party payor policies and how to apply this knowledge to your everyday practice. 

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Learn about the complexities of third-party payor policies and their value in applying quality controls in drug plan management. 

Understand how billing and coding errors can trigger an audit, and how to minimize your risk and make responding to audit requests easier for you and your pharmacy team. 

Familiarize yourself with the language of third-party payor policies and gain a better understanding of the components of a third-party payor agreement. Case studies are integrated in each module to assist in translating knowledge into practice.

Learning Objectives:

By the end of this course, you should be able to: 

  • Identify the different components of a third-party provider agreement. 
  • Recognize reasons for third party payors audits. 
  • Identify top audit triggers in order to prevent them. 

Course Outline:

  • Module 1:
    Understanding Third-party Payor Policies and Provider Agreements
  • Module 2:
    How to Prepare for Third-party Audits
  • Module 3:
    Minimizing Risks of Third-party Payor Audits
  • Reflective Exercise
  • Program Evaluation

Course at a Glance:

Who Should Take This Course:

Pharmacists, pharmacy technicians, pharmacy students, and assistants who want to confidently bill prescriptions using various insurance plans. 

Development Team:

Cancelation Policy:

Please refer to OPA’s Terms and Conditions of Purchase for cancellation policies.