Get Express Scripts Pharmacy Audit Grievance Form

Completing the Express Scripts Pharmacy Audit Grievance Form online can be a straightforward process when you follow the right steps. This guide provides a clear and supportive approach to help you fill out the form correctly and efficiently.

Follow the steps to complete the form with ease.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the date at the top of the form, ensuring it is accurate and reflects the current date.
3. Address the form to the appropriate party by entering the name under 'Attention.' This could be a specific department or individual related to audit grievances.
4. Provide details of the pharmacy by entering the name, NABP number, contact information, and address in the designated fields.
5. Include the audit number and audit date when applicable, ensuring these numbers are accurate for reference.
6. Select the claim type by checking the appropriate box, choosing between 'Med D,' 'TRICARE,' or 'Other.'
7. Input the prescription number and the date(s) of fill related to the dispute.
8. Clearly state the reason for the dispute in the provided section.
9. List any discrepancy codes relevant to the claim by entering them in the indicated area.
10. Compose a clear and concise explanation of your grievance in the designated field. Ensure you include any supporting evidentiary documentation that addresses the audit's findings.
11. Confirm that you have attached all required documentation, such as photocopies of the original prescription and any necessary proof of claims, as specified in the accepted documentation section.
12. Review the entire form for completeness, ensuring you have filled out all sections and provided all necessary attachments.
13. Once satisfied with the information provided, you can save your changes, download the form, print it, or share it as needed.

Start filling out your Express Scripts Pharmacy Audit Grievance Form online today to ensure your concerns are addressed.