Evidence record
Managed Care Pharmacy Claims Paid to ReCept Pharmacy #1
- Jurisdiction
- Texas
- Audit organization
- Texas Health and Human Services Office of Inspector General
- Publication date
- August 22, 2022
- Source record
- Original document linked
Findings
2
Recommendations
2
Overall conclusion
ReCept Pharmacy #1 properly billed for paid claims and complied with applicable contractual, Texas Administrative Code, and federal requirements for most claims tested; however, ReCept did not consistently comply with requirements for accurate claims submissions and dispensing labels.
Scope
The audit scope covered the period from September 1, 2020, through August 31, 2021.
Findings (2)
Each finding has a stable link.
- F-1124
Administrative errors in claims submission: two claims with errors—one with zero authorized refills when two were authorized; one with an incorrect dispense as written (DAW) code.
- F-1125
Dispensing label errors: for 20 of 60 claims, the dispensing label listed remaining refills that did not align with the prescription’s total remaining refills, primarily involving injectable pen medications.
Recommendations (2)
- R-986
Continue to ensure accurate submission of the correct number of authorized refills and the correct DAW code for each claim in accordance with contractual and Texas Administrative Code requirements.
Related finding F-1124 - R-987
Ensure the number of authorized refills remaining on the dispensing label is accurate prior to dispensing medications.
Related finding F-1125