Prescription claim audits are among the most valuable reviews of self-funded employee benefits for improving plan performance and managing costs.
We pioneered many of today’s best practices and continuously improve them.
Following your prescription benefit plan audit with continuous monitoring using the same methods and software is the best way to manage your plan. Our plan audit reports and data are created strategic management tools that provide insight into prescription medicine benefits claim payments. They provide excellent oversight of third-party administrators and help in-house plan managers with detailed information. In the event of sudden cost increases or unexpected budget fluctuations, explanations are forthcoming with continuously monitored plans. The monitoring service typically saves more than it costs.
How are Prescription Claim Auditing Companies Different?
One of the things that set TFG Partners apart from many of our competitors is that we are specialists in the field. Our auditors who perform prescription drug audits work hand-in-hand with medical claim auditing services for self-funded plans. Large employers of many types, from corporate to institutional/nonprofit, depend on our expertise to keep their plans functioning better. We help our clients comply with ERISA and Sarbanes-Oxley audit requirements and any that exist at the state level. Because we review every prescription benefits claim every time, we are thorough and complete – with accuracy that random samples can’t match.
Our people come from large medical plan backgrounds and have a deep understanding of claim processing and the related software and methodology. We’re ahead of the curve with new methods and have pioneered many best practices that today are industry standards. We bring the same knowledge and expertise to your plan when we audit your prescription medicine claims. No matter which claims administrator you use, you can rest assured that we’re prepared to audit them with ease; we’ve worked with every company in the business. The consistent goal is to improve plan performance and manage costs.
TFG Partners Can Improve Your Prescription Drug Plan’s Performance in Ways that Help Employees and Your Bottom Line.
TFG Partners serves many Fortune 500 corporations, as well as many medium to smaller companies.
We’re Advocates, Ready to Put Audit Results to Use Immediately
- TFG works directly with prescription drug administrators on behalf of clients. We’ve worked with all of them.
- We are independent and 100-percent committed to helping identify and implement best practices.
- Our prescription drug claim audits help companies define and address problems, no matter where they exist in the system.
Step #1: Reviewing Plan Benefits
- Intensive plan document review
- Confirm the intent of prescription claims audit
- Clarification of benefits not defined
- Review of administrator-imposed audit and recovery limitations
- Customization of specific prescription drug plan design
- Support for additional custom review needs, by request
Step #2: Audit and Analysis
- More accurate and actionable results.
- A comprehensive overview of all potential over-payments, regardless of a drug plan’s attributes.
- Deeper insight into why errors have occurred and what will prevent them in the future.
- Objective and fact-based assessment of administrator performance.
- Meticulous and tactful assistance in bringing about process improvements.
Step #3: Advice
- Better, more accurate prescription drug claims audit and adjudication
- Detailed compliance with ERISA and Sarbanes-Oxley
- Systematic/plan-wide error prevention
Step #4: Recovery
- We have facilitated the recovery of many millions of dollars
- The dollars are refunded directly to our clients’ plans
Prescription Claim Audits Have Many Benefits
Also, not enough can be said about the value of conducting an Rx audit for prescription plan claims. Furthermore, continuous monitoring following a claims audit can help members, especially those in high-deductible plans. Keeping a close watch for over-payments, double-payments, and other errors benefits members as well as the plan sponsor. When plans are not audited and monitored, it’s much more likely that claim administration is accurate. A well-run plan is the objective of every company, and in-house managers know the time it can take to recover payments made in error. It’s always a better approach to manage and audit closely and keep claim payments on track.
TFG Audits Leverage Our Secure, Proprietary Software
As pioneers of the 100-percent audit method in which all claims are reviewed, TFG’s technology was initially a breakthrough and has continuously improved ever since. It safeguards your data’s security, and every prescription medicine plan audit includes an electronic claim review followed up by human oversight. Our people only audit benefit plans and have an unmatched level of experience and expertise. They bring it to every project, helping us produce highly accurate results promptly and at competitive fees. We’re very different from large generalist firms that audit benefit plans as a sideline.
If you’re ready to step up to more thorough and accurate prescription drug auditing, and if you’d like help managing your plan or monitoring it continuously, let TFG Partners help. We’re industry leaders in prescription claim audits and have experience with every type of plan and TPA. We’re benefits auditing specialists with an excellent track record of success and easy on your budget. We always help you recover more than our service’s cost – and for virtually all clients, end up saving them significant sums of money over the long term with the best prescription plan audits.
