Clerical error protections
Discrepancies that do not affect payment (e.g., typo in directions, missing date) are protected as clerical errors — we invoke the statute to block recoupment.
The most rigorous PBM audit response a pharmacy can file.
RxShield assembles a documentation-complete audit defense and appeal pack — every flagged claim reconciled against the prescription record, every discrepancy mapped to state fair-audit law and the PBM provider manual, and every recoverable dollar reclaimed — checked against a proprietary defense library before a licensed pharmacist signs the release.
Every flagged claim reconciled to Rx image & signature logState fair-audit statute & provider manual mapped per findingDHSMV · USCG · UCC · judgment lien searchesLicensed pharmacist signs every release5-business-day SLA
Why audits hurt
A single missed deadline can cost you $26,000.
Every independent and specialty pharmacy faces recurring PBM and Medicare Part D audits that retroactively claw back paid claims — full-claim recoupments triggered by documentation discrepancies such as days' supply, refill-too-soon, missing DAW notes, and signature-log gaps. The average recoupment is over $26,000 per pharmacy per year, but ~93% of it is typically defensible when the pharmacy responds correctly and on time and invokes its appeal rights.
Most pharmacies run this by hand, from memory, between filling scripts. The provider manual has not been read since the last audit. That is exactly where completeness gaps hide.
RxShield exists to close that gap with a single, exhaustive standard applied identically to every file.
93%
of clawback dollars are typically recoverable with a proper defense
The benchmark
Measured against the letter of the statute and the PBM provider manual — subsection by subsection.
We do not summarize the law and hope. Every pack is scored against a versioned rule pack tied to the exact text of applicable state fair-audit statutes and the specific PBM provider manual. These are the provisions each pack is held to.
Audit appeal procedures
Every appeal must cite the exact manual provision and be filed within the contractual window — we map each finding to the correct clause.
Part D audit standards
Medicare Part D plan audits must follow CMS guidelines; we verify that the audit complies and flag any overreach.
Signature log & hard-copy requirements
We reconcile each flagged claim against the signature log, hard copy, and invoice/NDC — any discrepancy that is a documentation technicality is defended.
Days' supply & refill-too-soon calculations
We compute true days' supply from the prescription and fill history, and challenge any miscalculation by the PBM.
DAW & brand-name documentation
Dispense-as-written (DAW) codes and brand-name documentation requirements are verified against the prescription and state law; missing DAW notes are defended as clerical if the dispensed drug matches the prescription.
How a pack is built
Intake to pharmacist release, with deterministic gates the AI cannot overrule.
AI extracts and drafts. Deterministic rules — running as code, outside the model — decide what is complete. A licensed pharmacist validates every release. That order is never reversed.
01
Audit Vulnerability Scan
Upload the audit notice and your dispensing records. We return a free completeness read: which claims are defensible, which are at risk, and what documentation is missing.
02
Evidence & record retrieval
As your authorized clerical agent, we pull the Rx images, signature logs, hard copies, and invoices from your pharmacy management system and build the claim-level evidence matrix.
03
Grounded drafting
Each disputed claim is reconciled against the source documents; the discrepancy is classified and mapped to the strongest available defense under state law and the PBM manual.
04
Deterministic completeness gates
Every claim is checked: days' supply math verified, refill interval computed, DAW code validated, signature log matched, hard copy present. Any failure blocks release.
05
Pharmacist release
A licensed pharmacist reviews the exception queue and signs the release. High-dollar or complex cases route to a compliance attorney first.
06
Delivery
You receive the pack: completed audit response, appeal letter, evidence log, and filing instructions — ready for the pharmacy to submit under its own name.
The bar we hold
Rigor you can measure.
100%
Pharmacist-released
No pack ships without a licensed pharmacist's signature.
5 days
Standard SLA
From complete intake to released pack.
<1%
Critical-defect target
Tracked against a gold-standard defense library.
93%
Average clawback reduction
Based on industry benchmarks for properly defended audits.
Why RxShield
Built to be the most thorough option a pharmacy has.
Documentation-complete, by design
The deliverable is completeness itself — every claim reconciled, every defense cited, every exception coded. Nothing is left implicit.
Deterministic, not vibes
The gates that decide completeness are code, not a model's opinion. A drafting error cannot slip past a statutory requirement.
In its lane, on purpose
We prepare documentation and run searches as your clerical agent. We never contact the PBM, give legal advice, or conduct the audit.
Engagement
Flat fee per audit, plus a contingency share of dollars saved. No hourly billing, ever.
Simple, predictable, and aligned with a documentation standard — not a cut of any recovery.
- A free Audit Vulnerability Scan before you commit — see exactly which claims are defensible.
- One flat fee per defended audit; disclosed pass-through record-retrieval costs.
- Contingency share of clawback dollars saved/recovered (typically 20-30%).
- Optional fixed-fee attorney review for high-dollar or complex audits.
FAQ
Questions, answered precisely.
Is RxShield a law firm?
No. RxShield, a service of Your Deputy, Obuke LLC, provides documentation-completeness services. It is not a law firm, does not provide legal advice, and does not represent you in any legal matter. Attorney review is available and recommended for high-dollar or complex audits.
Do you contact the PBM or collect the clawback?
Never. RxShield is not a debt collector and does not contact PBMs or payers. The pharmacy remains the party responsible for submitting the audit response and any appeal.
What makes a pack 'complete'?
Completeness is defined by the statute and the PBM manual: every flagged claim reconciled, every discrepancy mapped to a defense, days' supply verified, signature log matched, and appeal rights invoked. Deterministic gates enforce each one before release.
How fast is it?
The standard SLA is five business days from complete intake to a pharmacist-released pack. The free Vulnerability Scan is returned much sooner and tells you exactly which claims are at risk.
How are you priced?
A flat fee per defended audit, plus a contingency share of clawback dollars saved/recovered. No hourly billing and no percentage of any recovered amount beyond the agreed contingency.
See what's defensible before you lose another dollar.
Start with a free Audit Vulnerability Scan. Send your audit notice and dispensing records and we'll return a completeness read against every applicable statute and manual provision.
Documentation-completeness service · not legal advice · the pharmacy submits every response.