PBM and DIR audits are not rare events - they are a routine cost of staying in-network. When an audit notice arrives, the pharmacies that lose money are the ones scrambling to assemble signatures, invoices, and override documentation after the fact, often inside a tight appeal window.
Most recoupments trace back to a handful of missing habits: unmatched claims, missing signed records, NDC billed-versus-dispensed mismatches, and undocumented DAW overrides. Each one is individually cheap to fix and expensive to ignore. The scorecard above turns those habits into a single number so you know where you stand before an auditor tells you.
How RxDelta helps close the reconciliation gaps
RxDelta reconciles every billing claim against what you actually purchased, flags NDC swaps automatically, surfaces MAC underpayments to appeal, and keeps an auditable record of the matches - the exact evidence trail an audit asks for. It cannot write your SOP for you, but it removes the reconciliation and NDC-verification gaps that drive the most expensive findings.