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Pharmacy claims audits are highly valuable reviews of self-funded employee benefits when it comes to improving plan performance and better managing costs. At TFG Partners, we’re among the best-known pharmacy claim auditing companies with unrivaled proprietary software and audit methods. Our pharmaceutical benefits plan audits check 100-percent of claims paid for maximum accuracy. While our competitors are random sampling or taking shortcuts, we’re diligently reviewing individual payments electronically and with human oversight. We introduced many of the best methods in use today and improve them continuously.
After a pharmacy benefit plan audit, it benefits your company and plan members to monitor continuously with the same methods and software. Our plan monitoring and audit reports are powerful strategic management tools with information on every pharmaceutical benefits claim payment. They give clear oversight of third-party administrators and assist in-house staff with detailed information. When sudden cost increases or unexpected budget fluctuations occur, real-time explanations are invaluable to management decision-making. Monitoring claim payment continuously service nearly always saves more than it costs.
TFG Partners serves many Fortune 500 corporations, as well as many medium to smaller companies.
How are Pharmacy Claim Auditing Firms Different?
One of the major differences between TFG Partners and many of our competitors is that we specialize in this field. pharmacy plan audits work in conjunction with medical claim auditing services for self-funded benefit plans. Our expertise keeps plans working better for large employers of all types, from corporate to institutional/nonprofit. We assist our clients in complying with audits required by ERISA and Sarbanes-Oxley and similar requirements that exist at the state level. Because we check every pharmaceutical benefits claim, we are more thorough — and with unrivaled accuracy that random sample methods can’t match.
At TFG Partners, our team has large medical plan experience and expertise in claim processing along with knowledge of the related software and methodology. We pioneer new methods and have developed best practices that have become industry standards. We put our knowledge to work for your plan when we audit your pharmacy benefit claims. Regardless of the claims administrator you use, you can trust that we’re prepared to audit them with professionalism and we’ve worked with every TPA in the business. Our unwavering goal is to improve plan performance and control costs.
TFG Partners Can Improve Your Pharmacy Plan’s Performance in Ways that Help Employees and Your Bottom Line.
We’re Advocates, Ready to Put Audit Results to Use Immediately
- TFG works directly with pharmacy claim administrators on behalf of clients. We’ve worked with all of them.
- We are independent and 100-percent committed to helping identify and implement best practices.
- Our pharmacy claim audits help companies define and address problems, no matter where they exist in the system.
Step #1: Reviewing Plan Benefits
- Intensive plan document review
- Confirm the intent of pharmacy claims
- Clarification of benefits not defined
- Review of administrator-imposed audit and recovery limitations
- Customization of specific pharmacy plan design
- Support for additional custom review needs, by request
Step #2: Audit and Analysis
- More accurate and actionable audit results
- A comprehensive overview of all potential overpayments, regardless of a plan’s attributes
- Deeper insight into why errors have occurred and what will prevent them in the future
- Objective and fact-based assessment of administrator performance
- Meticulous and tactful assistance in bringing about process improvements
Step #3: Advice
- Better, more accurate pharmacy claims adjudication
- Detailed compliance with ERISA and Sarbanes-Oxley
- Systematic/plan-wide error prevention
Step #4: Recovery
- We have facilitated the recovery of many millions of dollars
- The dollars are refunded directly to our clients’ plans
Auditing Pharmacy Benefit Plans Has Multiple Benefits
Each benefit plan for pharmaceutical medicine’s design and formulary are one-of-a-kind and need to be followed carefully. While TPA’s routinely promise to be thorough, only an independent pharmaceutical claim auditing company like TFG Partners can review and confirm it. For example, a way that many plans go off track scripts are written for name-brand medicines and claims paid at their much-higher prices when generic versions are available. It’s a quick catch for skilled auditors and one that helps save surprising sums of money while making continuing to provide the needed outcomes for plan members – high-quality generics are just as safe and effective as name-brands.
Because outstanding member service is a goal of every plan, audits and monitoring add significant value, especially for those in high-deductible plans. Flagging over-payments, double-payments, and other errors helps members as well as the plan sponsor. When plans are audited and monitored more frequently claim administration is more accurate. A well-managed plan is the goal of every employer, and their in-house managers understand it’s time-consuming to recover payments made in error. Therefore, it’s a better approach to audit and monitor continuously to keep claim payments error-free.
Our Audits Run on Secure, Proprietary Software
As originators of the 100-percent audit method that reviews every claim, our technology was initially a breakthrough. It has improved continuously ever since and safeguards your data’s security. Each pharmaceutical plan audit includes an electronic claim review combined with human oversight. Our people audit benefit plans every day and have a level of experience few others can rival. We take pride in producing highly accurate results quickly and at competitive rates. We’re noticeably different from large generalist auditors that work on benefit plans as a sideline.
When your company is ready to step up to higher level of claim auditing, if you’d like help troubleshooting your plan or monitoring it continuously, let us at TFG Partners help. We’re the industry leaders for pharmacy claim auditing companies and have expertise with all types of plans and TPAs. Our people are benefits auditing specialists with an impressive track record of success and we go easy on your budget. Our goal is to help you recover more than our service’s cost – and for nearly all clients, we end up saving you significant sums of money with the best pharmacy plan audits.