100% adjudication and Stop-Loss reimbursement coverage. Real-time verification. Every prescription checked against your contract—from the first claim forward.
Start Protecting Your ClaimsBy the time traditional audits reveal overcharges, millions have already left your budget—and recovery is a battle you rarely win
Most pharmacy and Stop-Loss benefit audits sample a tiny fraction of claims—typically 1-5%. This means 95-99% of your prescription adjudications and Stop-Loss reimbursements are never verified against your contract terms.
When you only check a small sample, systematic overcharging patterns slip through unnoticed. The errors compound month after month, draining millions from your budget.
Audits happen months or even years after claims are processed. By the time errors are discovered, the money has been paid out—and getting it back is nearly impossible.
Random sampling is designed to catch random errors—but overcharging isn't random. It's systematic. Sampling misses the patterns that cost you the most money.
Traditional auditing is fundamentally reactive—it finds problems after the fact, when the money is gone and recovery is difficult. You need proactive protection from the first claim forward.
BenefitsBridge Partners delivers continuous claims monitoring that catches overcharges before they leave your budget—not months later
Every single claim and Stop-Loss reimbursement verified, not samples
We verify 100% of prescription adjudications and Stop-Loss reimbursements against your contract terms—no sampling, no statistical estimates, no gaps. Every claim is checked from the first prescription forward.
Catch discrepancies as they occur
Claims are verified in real-time as they process. Discrepancies are identified immediately—not months later during an audit—enabling swift correction.
Immediate notification of contract deviations
When adjudications and Stop-Loss reimbursements don't match your contract terms, you're notified immediately. No waiting for audit reports—immediate visibility into contract compliance.
24/7 protection throughout contract term
Monitoring continues throughout your entire contract term—every single day, every single claim. Comprehensive protection that never stops.
We bring expert pharmacy and Stop-Loss benefit navigation combined with best-in-class monitoring technology. You get both the expertise to understand what should happen and the technology to ensure it does—from the first claim forward.
Measurable outcomes that protect your pharmacy and Stop-Loss budget every single day
Every prescription adjudication and Stop-Loss reimbursement is verified against your contract terms in real-time. No sampling means no blind spots—you get complete visibility into contract compliance across 100% of your claims.
Discrepancies are caught as they occur, not months later. Real-time monitoring means overcharges are identified immediately—enabling swift correction before losses compound.
When errors are caught in real-time, correction happens before money leaves your account. This isn't recovery—it's prevention. Dollars stay in your budget where they belong.
Every discrepancy is documented with complete audit trails. When you need to hold your PBM accountable, you have ironclad evidence of contract deviations—not estimates or samples.
The Challenge: A regional healthcare system with 15,000 covered lives was conducting traditional annual audits that sampled 3-5% of claims. They suspected systematic overcharging but couldn't prove it with statistical samples. By the time audit findings were ready, the money was gone.
The BBP Approach: We implemented continuous claims monitoring with 100% adjudication coverage. Every prescription was verified against contract terms in real-time. Discrepancies triggered immediate alerts, enabling swift correction before losses compounded.
The Results: Within the first year, our real-time monitoring identified systematic overcharging patterns that would have been invisible to traditional sampling. The client recovered $4.7M in overcharges—money that would have been permanently lost under the old audit approach.
This wasn't retrospective recovery—this was proactive prevention. Discrepancies were caught before dollars left the budget, not fought over months after payment.
Every element of your pharmacy and Stop-Loss contract verified in real-time across 100% of claims
Our comprehensive monitoring covers every aspect of your pharmacy and Stop-Loss contract—pricing, discounts, rebates, fees, plan design, and network compliance. Nothing escapes verification. Nothing gets missed.
Contact us today to learn how continuous claims monitoring can protect your pharmacy and Stop-Loss budget from Day One—catching overcharges in real-time, not months later.
Get Started