Claims Reconciliation (340B)
Definition
Claims reconciliation in the 340B context is the process of systematically comparing drug purchasing data (what was bought at 340B prices) against dispensing data (what was dispensed to eligible patients) and billing data (what was billed to payers) to identify discrepancies and verify program integrity.
Regular claims reconciliation helps covered entities detect compliance issues early—before they grow into significant findings. Common discrepancies that reconciliation can surface include: replenishment orders that don’t match eligible dispensing activity, billing records that suggest duplicate discount risk, and data gaps between the EHR, split-billing software, and purchasing systems.
Claims reconciliation is a core component of a continuous monitoring program and an essential element of audit readiness. Covered entities that perform regular reconciliation have documented evidence of their compliance oversight activities and can identify and correct issues proactively.
Frequently Asked Questions
Why Claims Reconciliation (340B) Matters
Claims reconciliation is the primary mechanism for detecting compliance issues before they become audit findings. Regular reconciliation demonstrates a proactive compliance culture and provides documented evidence of oversight activities.
How Virtue 340B Uses It
Virtue 340B performs claims reconciliation as a core component of our continuous monitoring service, comparing purchasing, dispensing, and billing data to identify discrepancies and compliance risks in real time.