TFG Partners – White Paper Summary
This white paper argues that for large, self-insured companies, checking 100% of their healthcare claims for errors is far better than the traditional method of checking just a random sample.
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Are There Red Flags in Your PBM Contract?
Any behind-the-scenes business practices of Pharmacy Benefit Managers (PBMs) can put Group Health Plan (GHP) sponsors and their executives in ever-greater legal jeopardy. The recent tightening of legal and regulatory requirements directly targets increasing transparency in PBM operations.
Fiduciary Duty
Catch and Correct Problems with
Continuous Monitoring Before Your Plan is Sued
Anyone involved in health care plans and payments today is aware of the growing number of fiduciary breach lawsuits, some of them sprawling class actions. Each new one reminds corporate plan sponsors about the value of medical and pharmacy claim auditing.
Doublecheck for Overcharges and Improper Billing
Anyone having anything to do with the U.S. healthcare system would love to hear good news about healthcare pricing and billing. But so far, none appears to be on the horizon. Instead, there is a steady drumbeat of news about a lack of accountability and trust. Everyone agrees there is a problem, but the solution(s) remain elusive. It puts employer-sponsored health plans in an incredibly tough position.
Pharmacy Claim Auditing Matters Now More Than Ever
Higher prescription costs and the need to reduce them are driving shake-ups in the PBM landscape. Today, we see an increasing number of health plans changing or questioning their pharmacy benefit managers (PBMs). In every case, there is a vital role to play in a thorough Request for Proposal (RFP) evaluation and negotiation, followed by Rx claim auditing and continuous monitoring. CONTINUE READING