TFG’s roots are in innovation
Our predecessor company evolved from the commercial health insurance industry’s medical claims processing and payment arena. So, its team had direct knowledge of the industry’s growing claims challenge: how to pay claims accurately and on time in the midst of the largest expansion of self-funded healthcare plans in U.S. history.
In the late 1980’s, the team saw an opportunity to solve this problem by harnessing recent advances in IT. Rapid increases in computing speed and capacity inspired them to create new software that could tackle large claim volumes with pinpoint accuracy.
By seizing this opportunity, our predecessor started a wave of progress in an industry that hadn’t seen much change in decades.
In the early 1990’s, continuing to exploit advances in IT, TFG Partners’ predecessor company pioneered another industry first – a new way of auditing medical claims. The method was to do a comprehensive electronic review of 100 percent of a plan’s claims and combine these results with a manual assessment of the computer-identified output, in order to derive a more accurate claim sample than had previously been possible.
We introduced the 100% method at a time when purely statistical, random sampling was common. Although random sampling is still being used by some practitioners today, it is far less accurate than the 100 percent methodology and typically leads to a lengthy, tedious, on-site validation process.
Claims administrators favored the random-sample methodology, because few payment errors can be identified that way, and a plan is only reimbursed for errors actually found. At the same time, for reimbursement purposes, extrapolation beyond the very minimal and restricted claim sample derived is not allowed. Finally, there was no alternative.
Today, many corporations,
large and small, see the
value in the
claims review method,
and its use is increasing.
Since the company was founded in 1991, we have continued emphasizing the 100% audit approach and have never stopped exploring ways to further improve it. To that end, and within a cost-neutral budget, we offer our clients far more value and service than simply fulfilling an audit requirement.
Throughout the remainder of the 1990’s, virtually no competitors emerged, and the company’s continuing success was largely based on demonstrating the value of this new methodology, versus the old administrator-accepted, statistical sample model. The list of large and medium-sized companies that retained our services continued to grow. In addition, many government entities, strictly bound by a competitive bidding process, retained the company as a sole-source vendor, thereby eliminating a previously bureaucratic process.
Entering the 21st Century, the benefits of our pioneering methodology became more widely known. More companies demanded this approach. Major national accounting firms and benefit consultants began to develop their own electronic audit strategies, or sought to purchase smaller boutique firms that began to find their way into the market.
Yet, we still find ourselves at the cutting edge. The many and specialized ways we have expanded and further improved our methodology over the past two decades have allowed us and our clients to gain fresh insights into the large and increasingly complex corporate expenditure represented by healthcare claims.