When it comes to managing self-funded health and pharmacy plans for large employers, an implementation audit might not be top of mind when transitioning to a new third-party administrator (TPA) or pharmacy benefit manager (PBM). However, medical and PBM auditing services are crucial at the start of any such relationship. Given the complexity and uniqueness of your plans, even the best TPA or PBM can make mistakes while uploading your plan specifics into their systems. That's why identifying errors early on—ideally around the 90-day mark—is essential for ensuring a smooth process. 

Many claim processors and plan sponsors recognize the value of implementation audits. On a practical level, these audits enhance processing accuracy and provide vital oversight. They offer reassurance that the work is being executed correctly, safeguarding against potentially costly errors. With healthcare and prescription costs continually rising, it's critical to ensure that mishaps and overcharges do not add extra financial strain. There's simply no room for error, and budgets are often tight. Implementation audits play a significant role in maintaining financial integrity and set the tone for more accuracy. 

The 90-day timeframe for audits is generally agreed upon because, by this point, enough experience has been gathered to assess performance without allowing mistakes to accumulate. This timing also allows TPAs and PBMs to fine-tune their systems, ensuring optimal operation tailored to each plan. Both parties share a common interest in achieving accuracy, and auditors play a crucial role as independent third parties to verify that standards are being met. Furthermore, the findings from these audits can reveal emerging trends, allowing all parties to manage costs more effectively. 

Especially during extraordinary circumstances, such as the recent coronavirus pandemic, continuous monitoring proved invaluable as costs soared. Plans with monitoring in place could track their expenditures in real-time, allowing them to react swiftly to unexpected financial challenges. Without this ongoing oversight, organizations risk operating in a reactive mode, only addressing errors after they have caused significant issues. With proper monitoring, you can maintain better control over your health plan costs, serve members effectively, and meet your fiduciary responsibilities more efficiently.