Fast, almost real-time feedback on how well your plans are performing, thereby improving your oversight as required as fiduciary of your organizations benefit plans
Continuous Benefit Claim Monitoring
Manage Costs and Performance Effectively
Continuous benefit claim monitoring from TFG Partners empowers you to manage your self-funded plan’s medical, pharmacy, and other investments more accurately and in less time than ever before. Our Continuous Monitoring Service combines analytics and oversight in a one-of-a-kind approach.
With TFG’s monthly reports, you’ll receive actionable intelligence about your plans that you or your benefits consultant will find invaluable.
Continuous claim oversight is an excellent follow-up to a medical and prescription drug audit. It is a concrete way to ensure that your corporate benefits plans run correctly all the time, members are getting the benefits they need and are entitled to, and claims are being paid correctly.
Audits provide detailed information, excellent for compliance, but the data is retrospective, and audits take time to manage. With CM service, you can check every claim right after it is paid without effort from the HR team. It works in the background and provides you with information continuously.
With the CM service, you improve your proactive, more timely plan oversight. This is a key issue in today’s challenging and more litigious environment, where government agencies and members are increasingly holding plan sponsors accountable as fiduciaries of their benefit plans.
Further, consider that this approach can save hundreds of thousands yearly for your members and the plan, effectively paying for the service many times over.
Ongoing Claims Monitoring Has Many Advantages
The goal of continuous claims monitoring is to catch problems before they multiply.
It assures your employees receive the care they are promised, over-payments are avoided, and negotiated prices are honored. It also avoids long and difficult discussions with PBMs (pharmacy benefit managers) and medical TPAs (third-party administrators) to correct errors after the fact.
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 System’s Advantage: Technology + People
The technology-driven, proprietary systems we’ve developed over 30 years are among the most powerful in the industry, but our people and their experience make the difference. The electronic portion of our claim reviews is comprehensive, and our auditors’ unique expertise augments it.
Few pharmacy and medical claim auditing firms can match our deep medical and pharmacy billing understanding. We understand it from all sides and are abreast of changes and new developments as they occur. Our knowledge and attention to detail give you peace of mind and the needed data.
Our System’s Advantage: Technology + People
The technology-driven, proprietary systems we’ve developed over 30 years are among the most powerful in the industry, but our people and their experience make the difference. The electronic portion of our claim reviews is comprehensive, and our auditors’ unique expertise augments it.
Few pharmacy and medical claim auditing firms can match our deep medical and pharmacy billing understanding. We understand it from all sides and are abreast of changes and new developments as they occur. Our knowledge and attention to detail give you peace of mind and the needed data.
What Makes TFG Partners Unique in the Field?
As the pioneer in the full-service, 100-percent benefit claims auditing space, we offer the most accurate continuous benefit claim monitoring. We keep your company ahead of the curve by reviewing payments in near real-time – and the systems and methods we’ve developed are renowned for their accuracy.
Monitoring claims continuously is a highly effective way to ensure things stay on track with corporate benefits plans.
With savings often exceeding eight to ten times the price of services, having us continuously review your medical and pharmacy claims makes economic sense. We can save your company plans much more than the price of our services. We’ll also help you serve members better and meet their needs.
How Does Set Up and Pricing Work?
Start-up for continuous monitoring service is easy and handled nearly entirely by our staff. Once your company signs the service agreement, we work directly with your TPA and PBM to establish a secure data exchange. We also load all contractual terms and details into our system and can receive claims and produce your first reports within six to eight weeks after kick-off.
As benefit claims enter our system, we will work with your claim administrators to ensure the review is accurate and accounts for all provisions of your plan.
The service is billed based on a straightforward fixed fee at the start of each quarter. The price is surprisingly cost-effective and, in most situations, far lower than the savings you’ll net.
What are Continuous Monitoring Reports Like?
The continuous monitoring reports you’ll receive are insightful, actionable, and easy to read. They include several components, including suggestions and recommendations to improve the performance of your plans. Our focus is on compliance, reducing costs, and serving your members better.
Monthly Status Reports and Quarterly Financial Performance Reviews are designed to keep you informed about progress and any performance gaps. These reports are also available online for your team members, making it easy to access the latest information at any time and any place.
Annual Summary Report, covering all TFG Partners findings, including any projected refunds, offsets, and areas of disagreement with your PBM, and a complete exception analysis and detailed results report, provided as soon as possible after close of your plan year.
Final Validation of your PBM’s Plan Year Reconciliation and Recommendations, an easy to understand final document that validates your TPA/PBM year-end discount reconciliation (Typically 90 days after close of plan year) and rebate reconciliation (Typically 180 days after close of pan year) and identifies any outstanding financial issues and resolutions.
Nothing substitutes for factual data; with reports in hand, you’re in a stronger position for management, oversight, and negotiation.