Pharmacy Claims Audit Services
Reduce Costs.
Ensure Accuracy.
Protect Your Plan.
Caribou Systems, part of the ELMCRx family of companies, is an independent pharmacy analytics firm specializing in expert Pharmacy Claims Audit Services. Caribou helps plan sponsors improve compliance, ensure benefit accuracy, and cut costs. From implementation and plan benefit audits to financial audits and ongoing claims monitoring, Caribou delivers clear, actionable insights that help you maintain compliance, control spending, and improve member satisfaction.
End-to-End Pharmacy Claims Auditing
Caribou's suite of audit solutions is designed to meet the needs of plan sponsors, brokers, and payers, whether you’re launching a new plan, evaluating ongoing performance, or ensuring benefit accuracy.
Pre-Implementation Audits
Validate new or updated benefit setup before going live, ensuring PBM documentation, benefit interpretation, and claims adjudication are accurate.
Plan Benefit Audits
Re-adjudicate 100% of paid claims to verify the accuracy of member contribution and clinical plan design attributes.
Rebate Audits
Evaluate per-claim rebate guarantees, pass-through shares, and final reconciliations to ensure you receive all rebate dollars owed.
Ongoing Claims Monitoring
Conduct continuous claim reviews to detect and correct errors, control costs, and improve member satisfaction.
Post-Implementation Audits
Review claims shortly after launch to confirm correct benefit setup, updated financial terms, and a smooth member experience.
Financial Audits
Identify pricing discrepancies, missed discounts, duplicate claims, and other payment errors that harm your bottom line.
Medicare Part D Audits
Ensure accurate administration of Medicare Part D benefits, maximize government subsidies, and maintain CMS compliance.
Independent, technology-driven audits that deliver transparency, accuracy, and significant cost savings.
Maximize Accuracy and Savings. Minimize Risk.
Caribou's audits don’t just identify costly errors and discrepancies. They provide the insight and clarity you need to enhance PBM performance and protect your plan long-term.
Compliance Assurance
Meet regulatory requirements and exceed fiduciary responsibilities with thorough, independent audits.
Cost Control
Detect and correct overpayments, duplicate claims, and missed discounts and rebates to reduce unnecessary spend.
Continuous Improvement
Identify and implement strategies for cost savings and performance improvements.
Why Choose Caribou Systems?
Independent and Unbiased
As an independent auditing service with no PBM affiliations, you get unbiased data and recommendations you can trust.
Technology-Driven Accuracy
Caribou's sophisticated methodologies, robust re-adjudication system, and advanced analytic tools deliver fast, precise results at scale.
Proven Experience
With deep pharmacy benefit experience and millions of claims audited, Caribou brings unmatched insight into PBM performance.
Tailored Solutions
Caribou's comprehensive range of audit services is tailored to meet your specific needs and goals, ensuring optimal outcomes for all stakeholders.
Protect your plan and uncover hidden savings with Pharmacy Claims Audit Solutions from Caribou Systems, part of the ELMCRx family of companies.