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TFGPartners posted a blog post

Auditing Claim Administrators Pays Off

Large corporate and nonprofit employers providing medical and prescription plans for their employees have significant financial stakes in ensuring the accuracy and efficiency of their claims processing systems. Given the magnitude of financial transactions involved, it becomes evident that medical claim auditing services are vital components when onboarding new claim processors. These services, often…See More
Sep 10
TFGPartners posted a blog post

Tighten Up Benefit Claim Processing with Audits

Over the years, many larger employer-funded benefit plans have opted to outsource claim processing to large insurance carriers and pharmacy benefit managers, touting cost savings and superior results. However, the promises need verification by doublechecking claims in a medical and Rx audit to ensure commitments are being upheld and potential efficiencies are being maximized. While third-party…See More
Aug 28
TFGPartners posted a blog post

Fiduciary Responsibilities for Employer Health Plans

Large dollar amounts in medical and pharmacy plan claims make healthcare audit services a top priority for most plan sponsors. Regulations mandate that plans act in the best interests of their members, and accurately paying claims is vital. It is a significant concern for corporate and nonprofit employers who sponsor their plans as costs continue to rise. With no relief in sight, continuous…See More
Jul 23
TFGPartners posted a blog post

Skyrocketing Drug Prices Demand Scrutiny

Anyone involved in paying for prescription medicines knows the prices can be shocking. Therefore, you can imagine the impact on employer-funded health plans paying on behalf of members. In the current environment, running an Rx audit routinely makes excellent sense. New medicines come on the market yearly as others go off-patent and become available as generics. While everyone can program their…See More
May 12
TFGPartners posted a blog post

The Big Opportunity of Pharmacy Claim Audits

The ever-higher prices for new medications make news continually large employers self-funding employee benefits often bear the brunt. Therefore, running an Rx audit frequently makes sense to double-check claims paid. More than a few high-priced on-patent medications offer rebates and discounts to volume buyers, and audits help confirm your plan is credited. Today, pharmacy benefit managers…See More
Feb 27
TFGPartners posted a blog post

The Best Claim Audits Review Every Detail

Everyone knows auditing is a numbers game, but medical claim auditors double-check additional factors in the healthcare world. They look for coding errors, duplicate services, and other mistakes that add needless costs without improving member service. The game has changed since more powerful software ushered in an era of 100 percent reviews. It was a leap ahead from the days of random sampling when…See More
Feb 20
TFGPartners posted a blog post

The Discounts and Rebates of Rx Claims

The pricing structure for the pharmaceuticals paid for by employer-sponsored health plans often includes rebates and discounts. They can be deducted from the prices paid or credited later. In either case, tracking them across thousands of transactions is challenging, and an Rx audit can help. With their sophisticated systems, claim auditors can review thousands of transactions for accuracy and…See More
Jan 31
TFGPartners posted a blog post

Get Meaningful Savings from a Claim Audit

The prospects for financial gain are good when you schedule a healthcare audit of your company-funded medical plan. Claim audits often recover as much as four times their price in the mistakes and overpayments they flag. In the early days of such reviews, they were scheduled as a regulatory and compliance function. However, as audit software and systems have grown more accurate and…See More
Nov 29, 2023
TFGPartners posted a blog post

Optimizing Your Claim Audit Timing

Most employer-funded benefit plans audit themselves annually, if not more often, given the value of a claim review. If you're in-house managing a plan and are thinking of scheduling a healthcare audit, do it sooner than later. One of the best times is shortly before you plan and budget for next year. In addition to flagging recoverable errors, an audit provides factual data to compare with…See More
Jul 20, 2023
TFGPartners is now a member of The Word of God Holistic Wellness Institute
Jul 20, 2023

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TFGPartners's Blog

Auditing Claim Administrators Pays Off

Large corporate and nonprofit employers providing medical and prescription plans for their employees have significant financial stakes in ensuring the accuracy and efficiency of their claims processing systems. Given the magnitude of financial transactions involved, it becomes evident that medical claim auditing services are vital components…

Continue

Posted on September 10, 2024 at 9:59pm

Tighten Up Benefit Claim Processing with Audits

Over the years, many larger employer-funded benefit plans have opted to outsource claim processing to large insurance carriers and pharmacy benefit managers, touting cost savings and superior results. However, the promises need verification by doublechecking claims in a medical and Rx audit to ensure commitments are being upheld and potential…

Continue

Posted on August 28, 2024 at 9:40pm

Fiduciary Responsibilities for Employer Health Plans

Large dollar amounts in medical and pharmacy plan claims make healthcare audit services a top priority for most plan sponsors. Regulations mandate that plans act in the best interests of their members, and accurately paying claims is vital. It is a significant concern for corporate and nonprofit employers who sponsor their plans…

Continue

Posted on July 23, 2024 at 10:02pm

Skyrocketing Drug Prices Demand Scrutiny

Anyone involved in paying for prescription medicines knows the prices can be shocking. Therefore, you can imagine the impact on employer-funded health plans paying on behalf of members. In the current environment, running an Rx audit routinely makes excellent sense. New medicines come on the market yearly as others go off-patent and…

Continue

Posted on May 12, 2024 at 10:21pm

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