ClaimClear — 340B program-integrity & independent audit engine

Audience

340B covered entities with contract pharmacies — program managers, pharmacy directors, and compliance officers

Problem

Every contract-pharmacy 340B claim must trace to an eligible encounter with no diversion and no duplicate discount; a wrong claim risks a repayment demand, an HRSA finding, or removal from the program — while HRSA requires an annual independent audit and certified 340B talent is scarce.

Offer

Done-for-you independent 340B audits — Eligibility Match, Compliance Lint, Duplicate-Discount Reconciliation — reviewed and signed by an Apexus-certified 340B expert and a pharmacist reviewer, priced per audit or per audited claim.

Operating process

[
  {
    "body": "Read-only TPA accumulator export, EHR encounter data, dispensing and purchasing records, and Medicaid carve-in status land in a secure, least-privilege engagement under a signed data agreement. An Audit Engagement opens and required-feed gating starts.",
    "title": "Connect your feeds"
  },
  {
    "body": "Every Audited Claim is classified and matched to an eligible encounter, priced against NDC/WAC, and tested against the Medicaid Exclusion File, GPO-prohibition, and sampling-integrity rules — each figure pinned to a source and a rule. Nothing is guessed — a required value with no source becomes a named exception.",
    "title": "Match and test every claim"
  },
  {
    "body": "Deterministic Medicaid Exclusion File, GPO-prohibition, and pricing checks run as code; every duplicate-discount discrepancy is drafted for compliant resolution before it becomes a finding.",
    "title": "Run Compliance Lint"
  },
  {
    "body": "An Apexus-certified 340B expert and a pharmacist reviewer verify contested-eligibility and low-confidence claims against the cited evidence and confirm the testing methodology. No anonymous output ships.",
    "title": "Certified Review clears the queue"
  },
  {
    "body": "The certified reviewer signs the Signed Independent Opinion within scope. You remain the covered entity of record to HRSA — we never certify or correspond with HRSA on your behalf.",
    "title": "We sign; you stay of record"
  },
  {
    "body": "The Audit Package — opinion, Exception Register, Recapture File, audit trail — ships to your authorizing official. A Continuous-Integrity Subscription keeps monitoring live between annual cycles, and the next independent audit is scheduled ahead of your HRSA deadline.",
    "title": "Deliver, defend, and renew"
  }
]

Evidence status

Domain-design coverage

Passed: 20; total: 20; coverage: 100.

Open the complete public blueprint DNA (JSON)