• medical claim audits by one of the best prescription auditing firms in the industry

    100% Claims Audits

    Medical, dental, prescription, COBRA, worker's compensation, HSA, HRA, eligibility/dependent verification

    About Our Auditing Services
  • continuous monitoring of company benefits and medical claims auditing services.

    Continuous Monitoring

    Real-time analysis and reporting with our proprietary software catches errors immediately and recommends improvements.

    About Continuous Monitoring

Full-Service Medical Claims Auditing and Monitoring

Our full-service approach to medical claims audits revolutionized the industry nearly 30 years ago. Today, we can improve the administration of your claims in real-time with continuous benefit claims monitoring. Since our founding, others have joined the field, but no one matches our level of service and accuracy. We have a long list of clients, many from the Fortune 50, that rely on us to improve the value of their health benefits plan investment and serve their employees better.

TFG Partners is a Medical Benefit Auditing Company in Pittsburgh, PA. A pharmacy claims audit is a review of your company's medical benefit plans by monitoring the claims. TFG Partners is one of the best medical claims auditing companies for medical, dental, prescription, COBRA, worker's compensation, HSA, HRA, and eligibility/dependent verification.
TFG provides continuous monitoring for medical claim auditing and prescription drug claims auditing.

At TFG Partners, we’re more than auditors for self-funded health plans and other benefits plans. We are advocates and advisors to our clients. Our team of senior-level experts collectively has more than 100 years of experience in the field. We take pride in our work and are champions of accuracy, insightful reporting, and a results-oriented approach. Our goal is to help you deliver the health care and other benefits promised to employees while improving your bottom line. Even though we are data and numbers experts, we have a people-oriented approach in everything we do.

Our Auditing Services

Will a medical claims audit and continuous benefits monitoring pay for themselves?

Our mission at TFG Partners is to make sure they do. It’s also why we take a full-service, cost-savings approach that views an audit as the starting point. Our legendarily thorough method (and powerful proprietary software) adds analysis, advice, recovery, and advocacy to what is traditionally considered an audit. The result is a budget-neutral process that uncovers efficiencies and cost-reduction opportunities. When you add continuous claims monitoring, you’ll serve your employees better and improve your bottom line immediately..

Read More About Our Services

Our Company Benefits Audit & Monitoring Service Has the Industry’s Highest ROI

We’re advocates to help our clients make the most productive use of audit results and continuous claims monitoring.

100% CONFIDENTIAL AND SECURE

SECURITY AND DATA PROTECTION ARE OUR HIGHEST PRIORITIES THROUGHOUT THE CLAIMS AUDITING PROCESS.

graphic representing medical claims auditing.
  • We work directly with administrators on behalf of our clients
  • TGF is fully independent and 100% dedicated to best practices
  • We root out and address problems anywhere in your system
  • Our knowledge of the industry and our abilities are unmatched by others
  • We make sure your plan achieves peak performance in all aspects

LEARN MORE ABOUT: OUR SECURITY

We are a leading medical claims auditing firm based in Pittsburgh PA. A medical claims auditing company can help save money by auditing pharmacy claims.

We identified issues and recoveries we did not expect and that more than paid for the audit, with the fixes helping our plan members, but most importantly I agree you have excellent service!

Until we audited, we did not know that our discounts were over $1 million short, and once refunded, we put TFG’s continuous monitoring service in place after which we saw that the PBM quickly put new specialty pricing in place to get in line with the promised discounts.

WE thought that a discount guarantee meant that we never pay more, but the TFG Continuous Monitoring Service also showed that drugs were reclassified to avoid outperforming that guaranteed amount. We make sure that we protect our members including those in High Deductible Plans so they get the lowest costs right away.

Recent news

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Pharmacy Plan Audits vs. Rx Co-Pay Optimizers

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TFG is one of the best medical claims auditing companies in the US. A pharmacy where a pharmacist is filling out prescription medication for an employee with a medical benefits plan for auditing.
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The Added Value of Medical Claims Auditing

When large and medium-size employers weigh the value of medical claims auditing and continuous claims monitoring service, we remind our clients there are added values to consider.At TFG Partners, our capabilities go far beyond flagging…
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How New Hospital Price Lists Can Help Medical Claim Auditing

The medical plan audits and continuous monitoring we provide at TFG Partners are expected to benefit from the Federal Hospital Price Transparency Rule that took effect on January 1, 2021. It requires hospitals to post prices online for 300 services,…
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Here are answers to questions
we are asked most frequently.

Yes; it is imperative. ERISA requires employers sponsoring health benefit plans to conduct audits from time to time. Plans also continue to change, and even the most accurate claims processing systems continue to produce significant error rates. An audit is the only way to make sure your employees receive precisely what your benefits plan calls for and the company is not paying for adjudication errors or uncovered benefits.

Cost of a 100 percent audit are similar to the cost of a sample based audit. However, net cost of the 100 percent audit are much lower: most 100 percent audits pay for themselves in actual recoveries while large employer experience savings that are a multiple of the audit cost.

Traditionally, our clients have realized recoveries of claims paid in error in excess of 2-3 times the cost of the audit. Savings over time, from cost avoidance through process improvements, will be much higher.

There are no set standards for audit frequency. Most clients prefer to audit every other year, or in the case of larger employers, annually and in some cases quarterly, for continuous quality improvement.

As the fiduciary of your plan, you have the right to choose the type of audit you want. Many administrators try to impose their own rules and limitations, mostly to limit the number of claims reviewed on-site, and staff time needed.

TFG Partners understands the reasons for these rules and has overcome these limitations, and built a reputation for both efficiency and accuracy. We have successfully audited all major carriers, using the 100 percent claims review audit process.

Continuous claims monitoring is another budget-neutral service from TFG Partners. It is very beneficial to your employees and your bottom line. It means we monitor every claim, in real-time, with our powerful proprietary software.

We catch errors and irregularities as they occur so they can be corrected immediately — and your administrator can put in place new methods to avoid similar errors in the future. It helps your medical and other benefits plans operate at peak efficiency at all times. Your employees will be better served and you’ll manage costs better.

Our average audit takes approximately 4-5 months in elapsed time, from the moment our auditors receive the data.

Most clients spend no more than 2-4 days (not consecutively) interacting with us. We pride ourselves in limiting your burden to only those tasks that are absolutely necessary for a quality audit. We do a lot of work behind the scenes to ensure this level of efficiency.

Audits should not affect employees at all. All overpayment recoveries are at the discretion of the employer. As a result, we typically work with the administrators to recover only at the direction of the employer, such as recoveries from Medicare, and other COB and duplicate payments to providers.

It depends on your objectives. TFG’s 100 percent audit uses computer technology to re-adjudicate and review every single claim, making sure all payments comply with specific plan rules, and identifying all exceptions. Accordingly, we are able to select a strategically focused sample of claims for on-site validation. Tests have shown that we are able to help our clients identify 4 times as many error categories this way and up to 14 times as many overpayments, compared to random sampling. Knowing what went wrong, by individual claim, allows us to determine what can be done to prevent future overpayments and can also help us guide you toward significantly higher recoveries.

By comparison, random sampling is accomplished by applying a statistical selection methodology to the claims data, providing only a statistically valid understanding of the error types and rates, which creates a reasonable estimate of the percentage of claims that have been incorrectly administered. This statistical methodology, therefore, does not provide any practical or detailed information to make significant process improvements and has significant recovery limitations.

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