Insights from TFG Partners
Major Improvement for Employer Plans on the Horizon The U.S. Senate’s HELP (Health, Education, Labor, and Pensions) Committee has advanced health price transparency legislation containing provisions that expand group health plan access to medical and Rx plan data, enhance explanation-of-benefits notices, and implement strict consumer data privacy rules. What was approved is Section 7 of the […]
The State of Maine is making important news in the benefits claim auditing field with the Act to Improve Accountability and Understanding of Data in Insurance Transactions. It’s a new law that became effective on January 1, 2026, and requires third party administrators (TPAs) and pharmacy benefit managers (PBMs) licensed in Maine to allow a […]
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.
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.
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.