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TIP: Maximize 340B savings by manually pulling in rejected and qualified claims.
Manually pulling in rejected and qualified claims in the TPA database is a critical step in capturing eligible 340B savings that may have been missed due to unmatched prescription data. Claims can fail to match automatically to an EMR (Electronic Medical Record) or ERX (Electronic Prescription) record due to discrepancies in provider documentation, timing issues, or data entry errors. By reviewing and manually adjudicating these claims, covered entities (CEs) can identify encounters that still meet 340B eligibility requirements but were not captured through automated matching. This practice ensures the entity maximizes its 340B benefit while maintaining program compliance.
Furthermore, this manual reconciliation process supports stronger audit preparedness and data integrity. By documenting the rationale for qualifying claims and ensuring proper linkage to eligible encounters, CEs can provide a defensible audit trail. It also helps identify patterns in rejected claims that may point to workflow or system issues, allowing for targeted improvements. Ultimately, consistently reviewing and processing unmatched claims manually helps optimize program performance while upholding the accuracy and accountability essential in 340B operations.
Sejal Patel is Senior Director of Client Success at Pillr Health. She can be reached at spatel@pillrhealth.com
