Our Services: Claim Audits, Monitoring, RFP Consulting
Health and Rx Plan Auditing is Only the Beginning
At TFG Partners, we provide a portfolio of services to help employer-funded employee benefit plans operate more cost-effectively while serving members well. Pharmacy and medical claim auditing is the cornerstone of our services, but we also offer equally valuable services before and after audits.
The “before” part of our service offering is RFP consulting, in which we help you find the best option for your plan’s needs. The “after” portion is a continuous monitoring service, with our audit software running in the background as your claims are paid, including monthly reports to provide ongoing oversight.
If your company or non-profit self-funds its employee benefits, getting to know us is wise.
We strive to deliver an outstanding ROI regardless of which services you choose. Our mission is to save your plan more money than the price we charge for our service. TFG Partners is a pioneer in the field and has been first or early to the table with many of the best practices used in claim auditing today.
Claim Audit, Analysis, and Advisory Services
Audit
- Medical Claim Audits
- Prescription Drug Claim Audits
- Dental Claim Audits
- COBRA
- Workers’ Compensation
- HSA, HRA
- Eligibility/Dependent verification (partnered)
Analysis
- 3rd Party Liability (Subrogation) assessment
- Fraud and abuse review
- Disease management/utilization of services effectiveness review
- Contract compliance
- Cost and utilization trending
Advisory
- Rx plan RFP consulting
- Contract terms
- Plan enhancement opportunities
- Service improvements to employees
- Cost reduction initiatives
Recovery
- Identification of opportunities
- Proactive outreach
- Liaison
- Tracking
An Important Reminder About Fiduciary Responsibilities
One of the most significant benefits of our services is ensuring your plan meets its fiduciary duty, which has recently become even more important. Closer oversight through claim auditing and analysis helps meet stricter regulatory requirements and defend against fiduciary breach lawsuits.
Our claim audit, advisory, and consulting services prioritize your plan’s fiduciary responsibilities. With years of experience and leadership in our field, we assure you of needed support in meeting financial and member service requirements.
An Important Reminder About Fiduciary Responsibilities
One of the most significant benefits of our services is ensuring your plan meets its fiduciary duty, which has recently become even more important. Closer oversight through claim auditing and analysis helps meet stricter regulatory requirements and defend against fiduciary breach lawsuits.
Our claim audit, advisory, and consulting services prioritize your plan’s fiduciary responsibilities. With years of experience and leadership in our field, we assure you of needed support in meeting financial and member service requirements.
Why Consider Monitoring Claim Payments Continuously?
Continuous monitoring is among our most requested services, and for good reason. When our audit system runs unobtrusively in the background, we ensure your medical and Rx claim administration operates at peak performance, flagging areas of concern before they grow into significant problems.
- Receive monthly reports
- No time required from you
- Provides near real-time plan oversight
Our monitoring service is valuable because the proprietary software we’ve developed to support it comes from decades of experience in benefits claim auditing. We’ve audited every claim administrator and can put the benefit of our expertise to work for your plan immediately.
The COVID-19 pandemic provided an ideal case study to support the value of continuously monitoring claim payments. TFG Partners clients with monitoring fared better because they could more quickly and definitively track and review what was occurring as usage and expenses skyrocketed.
An Extensive Offering of Benefit Plan Audit Services
TFG Partners’ menu of benefit plan audit services, including Rx and medical claim auditing, is among the industry’s most complete. We’re equipped to review all claims paid, and our 100-percent method catches details others may miss. As a result, the reports you receive from us are detailed, meaningful, and actionable, with irregularities flagged so you can recover overpayments and correct mistakes.
- Select services suited to your plan’s needs
- Add/subtract services as needed
- Benefit from our expertise
The bottom line is our audit, monitoring, and consulting services help your plan contain costs, serve members well, and meet its fiduciary responsibilities. We are a specialized benefit claim auditing firm that operates independently with only your plan’s best interests in mind. Call or contact us online today with questions or to get started on your plan’s next claim audit.