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Effective Claims Auditing for Prescription Benefits
TGLLC makes claims auditing for your prescription benefits easy. Thanks to the level of record keeping in pharmacy benefits, claim-to-claim comparisons are possible. Each prescription claim includes a record of the total cost of the prescription to the plan before the member's co-payment. Additionally, the date of prescription, its National Drug Code, and the name, strength, and quantity dispensed are recorded.
Zero-Balance Co-Payment
The zero balance co-payment occurs when the pharmacy benefit manager may allow for an artificial elevation in the cost of inexpensive drugs. This typically occurs with generic drug products. The plan cost is "0" and the member co-payment becomes the plan summary recorded co-payment but not the PBM "allowable" based upon MAC pricing.