Service Description

So far, all the hard work has been done by us. After claims have been identified that were paid by you and should not have been we will set about on the recovery phase of our job. Concurrently, we also will likely need to ensure that your PBM ceases payments for suspicious claims for certain drugs or pharmacies or claims that originated from suspect prescribers. We will work with you to notify the PBM exactly what changes need to be made to your plan design to protect you from further financial risk. This can be a very important part of savings for your organization. Once a suspect pharmacy identifies an employer that allows payment of their dubious claims, stopping a recurring pattern of fraudulent behavior by that pharmacy can save significant amounts of your benefit dollars over time. If your PBM paid claims in error or against the terms of your agreement with them, they will have to refund those dollars to you and we will help calculate that refund on your behalf. Remember, these are dollars that would not otherwise be identified by your HR Benefit Consultant or even by your annual PBM claims audit (if you have one). PBF only gets paid based on the amount and type of savings we deliver to your plan. Remember- if you dont save, we don't get paid. There is no financial risk for your organization. Contracting with PBF serves as an additional layer of protection against fraud, waste and abuse without a premium.