In a complex and ever-changing healthcare environment leveraging analytics has the power to transform healthcare. Trust TPG Data Services (TPG-DS) experts and our proprietary suite of data analytics tools to help payors and employers make smarter decisions to better manage limited resources and reduce costs.
Fraud, Waste and Abuse (F/W/A) Prevention
Given the recent trend of CMS becoming more vigilant in the Fraud, Waste, and Abuse arena, get proactive and implement the latest tools and expertise to combat F/W/A practices. The TPG-DS approach uses analytics to predict, monitor, identify, and ultimately work to effectuate change relating to potential F/W/A practices.
Most systems only analyze paid claims while TPG-DS examines a total situational view of all claims that led up to a paid claim searching for critical patterns. Our tool can be custom-tailored to meet your business priorities – whether monitoring prescribers, pharmacies, or member activities – reviewing all claims generated by the nexus of the member, provider, and pharmacy.
Utilizing our automated tool takes the hassle out of the time consuming practice to monitor F/W/A while identifying and communicating how to proactively change behavior to bend the cost curve.
We work closely with payors and employers with the goal of avoiding waste and calling out fraud and abuse with actionable and direct communications to the potential prescriber, pharmacy, or member in a timely manner.
Financial Auditing and Analytics
TPG-DS conducts a comprehensive analysis of claims data to quickly examine contract compliance, while identifying past financial claims errors to save you money.
Assess brand and drug pricing, rebate program adherence, prior authorization validation, and many other claims data points all at the touch of a button. Powered by the TPG-DS Claims Invoice Snapshot Tool, our clients:
- Reduce the complexity and time behind sifting thru volumes of data
- Deliver actionable advice to assist C-level suite decision-making
- Report automatically based on needs, yielding cost reduction opportunities
- Benefit from drug pricing expertise from TPG-DS financial and clinical performance experts
Don’t miss the chance to integrate a turnkey technology solution without the hassle of investing in additional IT resources.