Navitus Health Solutions, LLC provides pharmacy benefit services to a variety of clients, including health plans, managed-care organizations, self-funded employer groups, and union organizations. They strive to provide seamless benefit administration, world-class customer service, and a 100% transparent, pass-through business model where all negotiated pharmaceutical manufacturer rebates and pharmacy discounts are passed on to their clients. For this reason, when a large Navitus client requested validation of the internal business process controls surrounding management of pharmacy benefits, Navitus contacted Wipfli for an objective analysis.
Wipfli reviewed and validated 15 specific business processes related to configuration of the claims processing system and procedures, manufacturer rebate processing, client and pharmacy payments, and customer service. Wipfli then designed control points and tests to verify that the defined processes were consistently conducted in accordance with established policy and procedural guides that are periodically updated.
Navitus recognized that the deep experience of Wipfli’s Health Care team, particularly in the pharmacy benefit management sector, would provide additional value to the SAS 70 Audit process. The SAS 70 audit enabled the board of directors to confirm to its clients with confidence that its core business processes operate effectively and consistently. Further, this report validated that the controls utilized are suitably designed to achieve the control objectives specified, and those controls are complied with satisfactorily by the appropriate teams. Ultimately, this enabled Navitus to satisfy key client requirements and demonstrate to future clients its level of internal process controls