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).
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.
Review claims paid for benefit adherence, flag errors, suggest systemic improvements, create opportunities for cost savings, making sure Plan Administrators meet their fiduciary responsibilities.
Double-check for benefit adherence, discounts, rebates, and contractual and financial guarantees, making sure Plan Administrators meet their fiduciary responsibilities
Monthly reports, flag errors before they become significant, near real-time oversight
Start-to-finish management of the PBM RFP process to ensure an optimal agreement
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.
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.
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.
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.
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.
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.
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.
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.
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.
What does TFG Partners do?
TFG Partners is a medical benefit auditing company that reviews how third-party administrators (TPAs) and pharmacy benefit managers (PBMs) pay claims for self-funded, employer-sponsored health plans. Think of it as a healthcare claims audit that checks the actual bill, not just the promise, we review 100 percent of claims paid and validate the findings using a targeted sample. This is a far superior methodology as errors and overpayments as well as underpayments surface that a smaller random sample review would miss. Our medical benefit auditing services cover medical, pharmacy, and other benefit claim types.
What services does TFG Partners offer besides claims audits?
Audits are the core of our services, but not the whole picture. We also run continuous claims monitoring for month-to-month oversight between audits, and manage PBM RFPs when it’s time to select or renegotiate a pharmacy benefit manager contract. Most clients end up using two or three of these together rather than just one.
There are a lot of medical claim audit companies out there. How do we tell the accurate ones apart?
Every medical claim audit company will tell you they’re accurate. The real question is how many claims they actually look at and how thorough they look at these claims. Many firms review a sample and extrapolate an error rate; TFG Partners re-adjudicates 100 percent of claims against your specific plan rules instead using 3 to 4 times as many error algorithms compared to most others. Testing of TFG’s methodology has shown that approach catches roughly four times as many error categories and up to 14 times as many overpayments compared with sample-based audits — the kind of gap that matters when you’re comparing medical claims auditing firms.
Is TFG Partners an independent corporate claims auditor, or are you affiliated with any TPA or PBM?
No affiliations. TFG Partners has no financial ties to any insurance carrier, TPA, PBM, or broker — as a corporate claims auditor, our only relationship is with the plan sponsor who hires us, and our objectivity is key. We’ve audited essentially every major claims administrator in the industry, so there’s no vendor relationship to protect when we review your plan.
What is health plan claims auditing, and does TFG Partners work with plans of every size?
Health plan claims auditing means independently verifying that a self-funded employer’s medical, pharmacy, and other benefit claims were paid the way the plan document actually requires, rather than taking the administrator’s word for it. TFG Partners works with smaller firms with 1,000 members to mid-size and large employer plans all the way up to entire states and across most industries. Of course, the more members and the more complex the plan design, the more an audit like this tends to find.
Is a claims audit or continuous monitoring engagement actually worth the investment?
For most self-funded plans, yes. The industry’s error rate and resulting value of either service turns out to be such that almost all audits more than pay for themselves rather than sit on the books as pure overhead. The specific numbers differ by service (our audit ROI and continuous monitoring ROI pages break those out), but the underlying idea is the same across both: you’re paying in the first place to be a good steward or fiduciary of your plan but the audit improves your plan’s accuracy so members always receive their well-deserved benefits and you find money you’re already losing, not spending money you wouldn’t otherwise need to.