Insights from TFG Partners
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 […]
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 […]
The value of medical claim auditing for self-funded health plans is affirmed in many ways each year – it always pays to review what’s happening with your third-party processor. The latest example to make TPA oversight a topic in the news is a class-action lawsuit filed against UnitedHealthcare Group (“UHCG”) over out-of-network payments. The giant […]
It’s never been a better time to audit your Pharmacy Benefit Manager (PBM) and the claim payments it makes on your plan’s behalf. With drug price increases expected in 2023 for commercial and employer-sponsored health plans, keeping an eye on things will be vital.
If you’re a medical benefit plan manager and hearing about Rx co-pay optimizers, this article is for you. The question our clients have is, how much can an optimizer save my plan?