Expert Tip From Maxor


TIP: Be prepared to answer 340B claims eligibility questions in an audit.

Covered entities need to be prepared for the possibility of a 340B audit. That includes being able to respond to any audit questions about how you work with your 340B TPA to determine 340B claims eligibility. Be ready to address these four key areas:

  1. First, know what data is being sent to your 340B TPA/s and how often it is being sent.
  2. Second, you should be able to explain how the data is being used by your 340B TPA/s, what other data the TPA is receiving, and how the different data sets are utilized.
  3. Third, understand the filters/configurations/rules you have chosen to determine 340B claims eligibility in your 340B TPA software. Be able to articulate how they work and how you ensure they work as expected.
  4. Lastly, ensure the rules you have chosen to align with your policies and procedures.

If you aren’t prepared to respond to these claims eligibility questions today, prepare now for a potential audit by reviewing your policies and talking to your TPA.

Maxor340B is a TPA that values transparent partnerships with covered entities and helps them be fully prepared for audits.

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