1. Defined program ownership

Every major program activity should have an accountable owner, a backup, a review frequency, and clear evidence that the review occurred. Governance should extend beyond pharmacy when registration, eligibility, billing, contracting, or patient definition decisions involve other departments.

2. Current policies that match practice

Policies should describe the workflow that staff actually follow. A policy that is technically comprehensive but operationally inaccurate can create risk because it does not demonstrate effective oversight.

3. Routine transaction testing

Covered entities should test representative transactions across locations, payers, providers, mixed-use logic, Medicaid billing, and contract pharmacies. Testing should include both eligible and ineligible scenarios.

4. Reconciled source data

Registration records, provider lists, locations, contracts, accumulator configuration, and claims data should be reviewed together. Material differences should be investigated and documented.

5. Corrective action follow-through

Findings should have an owner, due date, documented resolution, and validation step. Closing the task is not the same as proving the underlying risk was corrected.

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