The Most Effective Claims Audits and Monitoring for Nearly 30 Years
The 1980s: TFG’s Roots are in Innovation
Our predecessor company evolved from the commercial health insurance industry’s medical claims processing and payment arena. So, we had direct knowledge of the growing claims challenge: how to pay claims accurately and on time amid the most significant expansion of self-funded healthcare plans in U.S. history.
During the late 1980s, our team saw an opportunity to solve the problem by capitalizing on advances in IT. Rapid increases in computing speed and capacity opened the door for us to create breakthrough software. It could handle large claim volumes with pinpoint accuracy.
By seizing the opportunity, we started a wave of progress in an industry that hadn’t seen much change in decades.
The Early 1990s: More Innovation
During the early 1990s, we continued to leverage advances in IT as TFG Partners’ predecessor company pioneered another industry first: a new way of auditing every medical claim.
Our pioneering method was a two-pronged process: a comprehensive electronic review of 100-percent of a plan’s claims and a manual assessment of the computer-identified output. It yielded the most accurate medical claim review that had ever been possible.
We introduced the 100% method at a time when purely statistical, random sampling was common. Although random sampling is still used by some practitioners today, it is far less accurate than our 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.
large and small
See the value in the
claims review method
And its use is increasing…
The TFG Partners Difference:
Since our founding in 1991, we have followed the 100-percent audit approach and have never stopped exploring ways to further improve it. As a result, and with a cost-neutral budget, we offer our clients far more value and service than simply fulfilling an audit requirement. Our full-service approach is second to none.
The Mid to Late 1990s: Only TFG Audits 100% of Claims
Throughout the remainder of the 1990s, virtually no competitors emerged, and our continuing success was primarily based on demonstrating the value of our unique methodology, versus the old administrator-accepted, statistical sample model.
The list of large and medium-sized companies that retained our services continued to grow. Also, many government entities, strictly bound by a competitive bidding process, retained us as a sole-source vendor, thereby eliminating a previously bureaucratic process.
Entering the 21st Century: The 100% Method Becomes Standard
As the 21st Century dawned, 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 started to find their way into the market.
Today: TFG Continues as the Innovator with Continuous Monitoring
We continue to find ourselves at the cutting edge with continuous monitoring. The many and specialized ways we have expanded and further improved our technology and methodology over the past two decades have kept us at the forefront of innovation.
It allows us and our clients to gain fresh insights into the large and increasingly complex corporate expenditure represented by health care and other benefit-program claims.