Continuous Monitoring of Benefit Claims
Serve Members Better and Manage Costs by Catching Errors Early
Ongoing claims monitoring makes plans perform better
TFG Partners provides continuous monitoring as an excellent follow-up to a medical and prescription drug audit. It is a concrete way to assure that your corporate benefits plans are running correctly all the time, assure members are getting the benefits they need and are entitled to, all while claims are being paid correctly.
Audits give you detailed information, great for compliance but the information is retrospective, and audits take time to manage. Now imagine that you can check every claim right after it is paid without effort from the HR team’s side but by using our service that continuously monitors all claims efficiently in the background. Further consider that this approach saves hundreds of thousands every year for your members and the plan, effectively paying for the service many times over.
Continuous Monitoring delivers:
- Fast, almost real-time feedback on how well your plans are performing
- Facts and assistance to fix errors and avoid under and overpayments before they hurt plan members or become unmanageable, and requires negotiation after the fact.
- Significant reduction in HR time involvement with a solution that effortlessly works in the background.
The goal of continuous claims monitoring is to catch problems before they multiply. It assures that employees receive the care they are promised, over-payments are avoided, and hard-negotiated discounts are honored. It also means plan managers avoid long and difficult discussions with PBMs and Medical TPAs to correct errors after the fact.
As the pioneer in the full-service, 100-percent benefit claims auditing space, TFG Partners offers the most accurate continuous monitoring. We keep your company ahead of the curve by reviewing benefits payments in near real-time. With savings often exceeding eight to ten times the cost of services, it makes economic sense. We can save your company plans much more than the price of our services. Monitoring claims continuously is a unique way to make sure things stay on track with corporate benefits plans.
TFG Monitors Rx Plans with CRM Service
Continuous claims monitoring from TFG will optimize your pharmacy plan — our auditors remind companies that negotiating the best PBM and PBM contract is only the beginning. Once things are underway, it’s crucial to make sure you are receiving the negotiated discounts. Contracts are complex and continually changing: Drug prices, new medications, reclassifications that can eliminate discounts, varying rebate levels, etc. It leaves many blind spots and loss of control unless you have a continuous monitoring system in place. We protect your plan and assure everything negotiated is genuinely delivered, on time, and all the time.
Our continuous Rx monitoring or CRM is a logical extension of an audit. We will collect claims data daily, weekly, or monthly throughout the year and, without any effort on your part, report our findings with convenient online access to results for you.
TFG Partners serves many Fortune 500 corporations, as well as many medium to smaller companies.
Continuous RX Monitoring Services Include:
- Invoice validation: You can immediately check if your bills are correct, and if you are not paying for drug claims or fees that were never incurred by your members;
- Discount and Rebate Checks: See how your PBM is performing in real-time against promised discount and rebate targets;
- Outlier Monitoring: Detect any new changes or surprises, such as new classifications, discount exceptions, overpriced medications, etc.;
- Hyperinflated Drug tracking: Medications that might be costly with low value, which in the case of High Deductible plans hurt members and drive up plan cost in all scenarios.
In summary, CRM tracks and proactively monitors all your claims and costs. In a simple internet-accessible report, you’ll see your company’s trends and any red flags that require attention. Discrepancies can be reported back to the PBM and dealt with early on, so your members receive prescription plan benefits as planned, and the company gets the promised savings.
Continuous prescription plan monitoring helps your company avoid significant cash flow variations and ends the frustration and wasted time of year-end crunches and haggling over refunds. It reduces the need for extensive adjustments and reconciliation of your PBM account long after the close of the year. Also, as a bonus, since all data is available, TFG Partners can easily and quickly set-up any market-check or RFP, so you will continue to benefit from the most up to date and competitive pricing and contract terms.
Continuous Medical Claims Monitoring with CMCM Service
Medical plans, billing, and contracts are complicated. Continuous Medical Claims Monitoring,or CMCM,from TFG makes sure your Third-Party Administrator (“TPA”) processes claims correctly. We track and flag issues early, and notify you and your TPA about incorrect plan adherence, administrative errors, and missed opportunities to coordinate benefits and reduce plan costs. Until now, most plan sponsors have only been able to assess the level of TPA performance long after the fact using audits.
Although audits will continue to play a role, we now enable benefit managers to stay ahead of the curve and receive feedback throughout the plan year — so corrections can be made near real-time and not long after the plan year has ended.
Our CMCM service, is the logical extension of a 100 -percent medical claims audit from TFG. We collect your company’s medical claims daily, weekly, or monthly and provide:
- Invoice validation: You can immediately confirm your bills are correct, and your company is not paying for medical claims or administrative fees that were never incurred by your members;
- Discount Checks: Our service reviews average discount levels In-Network as well as Out-of-Network so you can monitor how your TPAs network is delivering promised savings;
- Adjudication accuracy: Detect any medical or technical exceptions from duplicate claims payments to missed coordination of benefits with Medicare or other coverage;
- Cost outliers: From overly high-cost J-Code specialty charges to surprise Out -of -Network and recently COVID-19 related billing, our system flags outliers that require follow up by the TPA.
In a nutshell, with both the CRM and CMCM services from TFG Partners, your company will receive concise, easy-to-read reports. We summarize a special executive synopsis for your C-suite and provide continuous access to the plan score on the internet as well as any red flags that may require follow up. It will help your plans deliver peak performance.