Third-party Audits: The Ins and Outs

Learn the language of thirdparty 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:

  • 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:

  • 1.5 Hours to complete
  • Available until 30/09/2021
  • Online
  • Completion requirement: Complete the course’s online modules and achieve a score of 70 per cent on the multiple-choice exam.

Who should take this course:

Pharmacy professionals who want to improve their knowledge of third-party audits in their practice.

Development Team:

  • Jessica Pickering, BSc
  • Bessie Wang, MBA, CHRL