Health Plan Claim Auditing | Medical and Rx Specialists

TFG Partners is a leader in the industry for medical and pharmacy claims auditing. Our deep experience in the field, state-of-the-art technology, and pioneering methods assure you of accuracy and thoroughness – precisely what you need in an independent medical and pharmacy claim auditor.

We’re advocates who help you make the most productive use of audit and monitoring data.

No two employee benefits auditing firms are alike, and you understandably want the best for your employer-funded plans. We’ll arrive at the table ready to provide insight and oversight as we audit and monitor your third-party claim administrator (TPA) and pharmacy benefit manager (PBM).

Our claim audits and monitoring service delivers industry-leading returns on investment (ROIs).

Skyrocketing healthcare costs, general inflation, increasing regulatory requirements, and significant fiduciary responsibilities have employer-funded health plans under enormous pressure. We understand your needs and are ready to help while providing an excellent ROI on the dollars you budget for us.

Our Services: Claims Audits, Monitoring, RFP Management

Medical Claims Auditing

Review claims paid for benefit adherence, flag errors, suggest systemic improvements, create opportunities for cost savings, making sure Plan Administrators meet their fiduciary responsibilities.

Pharmacy Claims Auditing

Double-check for benefit adherence, discounts, rebates, and contractual and financial guarantees, making sure Plan Administrators meet their fiduciary responsibilities

Continuous Monitoring

Monthly reports, flag errors before they become significant, near real-time oversight

PBM RFP Management

Start-to-finish management of the PBM RFP process to ensure an optimal agreement

Claim Auditors and Pioneers in Our Field

TFG Partners’ full-service approach to medical and prescription plan audits revolutionized the industry with a 100 percent method of double-checking every claim. Today, we can provide unmatched and cost-effective oversight of your claim administration with continuous monitoring service.

  • Independent advocates and advisors to our clients
  • Senior team members with more than 100 years of collective experience in the field
  • A long list of clients in many industries and sectors, many Fortune 500
  • Champions of accuracy, insightful reporting, results-oriented approach
  • Valuable new services (i.e., continuous monitoring, PBM RFP consulting)

Since our founding, others have joined the field, but no one matches our level of service and accuracy. Our clients rely on us to enhance the value of their health benefits plan investments and better serve their employees. We do it with an unwavering commitment to your fiduciary responsibilities and bottom line.

Let Us Continuously Monitor Your Claim Payments

High-quality health plan claim audits are vitally important, but it’s in your plan’s best interest to view them as a starting point. Following an audit with our continuous monitoring service, you can expect an excellent return on investment and outstanding oversight of your claims administration.

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.
  • Near real-time reporting
  • Analysis, advice, recovery, and advocacy
  • Catch mistakes and irregularities as they happen
  • Discover cost-reduction opportunities
  • Budget-neutral (or better) process

When you add continuous claims monitoring, you’ll serve your employees better and immediately improve your bottom line. You’ll be impressed by its cost-effectiveness and stay on top of your plan oversight responsibilities with insightful monthly reports covering all pertinent data.

PBM RFP Management: An Important New Service

Pharmacy benefit managers have been making headlines recently, and not always in a positive light. Given the financial and legal/regulatory exposure your prescription plan faces, consider entrusting us to manage your next PBM RFP (Request for Proposal) process with thoroughness and expertise.

Financial analysis   Contract review   Operational performance

We’ll help ensure your Rx plan contract avoids common pitfalls while helping you maximize your investment, serve members well, meet regulatory requirements, and satisfy fiduciary responsibilities. There is no substitute for our expertise and the independent oversight we provide – our only interest is ensuring your plan has a PBM contract that meets your needs optimally.

Pharmacy benefit managers have been making headlines recently, and not always in a positive light. Given the financial and legal/regulatory exposure your prescription plan faces, consider entrusting us to manage your next PBM RFP (Request for Proposal) process with thoroughness and expertise.

  • Financial analysis
  • Contract review
  • Operational performance

We’ll help ensure your Rx plan contract avoids common pitfalls while helping you maximize your investment, serve members well, meet regulatory requirements, and satisfy fiduciary responsibilities. There is no substitute for our expertise and the independent oversight we provide – our only interest is ensuring your plan has a PBM contract that meets your needs optimally.

We Audit All Employee Benefit Plans

We specialize in medical and pharmacy claim audits because they are the most significant responsibilities and expanses for employer-funded benefits programs. However, our expertise extends to all types of claim review needs.

Medical and Pharmacy

Dental and Vision

COBRA

Worker’s Compensation

HSA and HRA

Medicare Part D and EGWP

Eligibility/Dependent Verification

Effective management of claim administrators requires thorough oversight, regardless of the type of benefit. We bring years of expertise and experience auditing every provider working in the field today. When you work with TFG Partners, you have a single firm to handle all your claim review needs.

TFG provides continuous monitoring for medical claim auditing and prescription drug claims auditing.

100% Confidential and Secure

Our proprietary audit systems provide exceptional security and data protection for your plan and members. Confidentiality is our highest priority throughout the audit and monitoring processes.

  • We work directly with administrators on behalf of your plan
  • TFG Partners is fully independent and security-focused
  • We root out and address problems anywhere in your system

In an era of data breaches and security concerns, we keep our systems among the industry’s safest and most secure. It’s the right thing to do for our clients and for the careful and precise way we operate.

Read What Our Clients Are Saying

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.

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Read the TFG Blog for Claim Auditing Insights

TFG Partners' full-service medical claim audit and benefits plan auditing services.
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White Paper Summary: Why 100 Percent Claims Audits Outperform Random Sample Audits Every Time

TFG Partners - White Paper Summary This white paper argues that for large, self-insured companies, checking 100% of their healthcare claims for errors is far better than the traditional method of checking just a random sample. The Problem:…
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RX auditing & continuous monitoring services by TFG Partners for fiduciary duty compliance.
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Rx Audits Are Vital to
Fiduciary Duty

Are There Red Flags in Your PBM Contract? Any behind-the-scenes business practices of Pharmacy Benefit Managers (PBMs) can put Group Health Plan (GHP) sponsors and their executives in ever-greater legal jeopardy. The recent tightening of legal…
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Auditing pharmacy, medical, and prescription claims can minimize the chance of fiduciary breach lawsuits.

Claim Auditing and The Latest Fiduciary Breach Lawsuit

Catch and Correct Problems with Continuous Monitoring Before Your Plan is Sued Anyone involved in health care plans and payments today is aware of the growing number of fiduciary breach lawsuits, some of them sprawling class actions. Each new…
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The Best Medical and Pharmacy Claim Auditing Firm for Your Plan

Since our founding more than 30 years ago, we’ve had a consistent goal at TFG Partners: to be the best medical and pharmacy claim auditors in the business. Everyone on our team is experienced and dedicated to providing the industry’s best benefit plan claim audits at excellent rates.

If you’re ready to learn more about how we can support your company’s plans, please call or contact us online today. We are fully independent claims auditors with an outstanding track record of delivering an excellent return on investment (ROI) to our clients. Your members and your bottom line will benefit from our work.


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