340B Optimization
Automate manual review processes for 340B claims
Scale 340B programs while de-risking exposure from compliance audits. Integrate TPA and EHR data to maximize eligible capture and surface revenue recapture opportunities.
How It Works
Continuous compliance and revenue optimization
Our platform automates time-consuming compliance audits by integrating TPA and EHR data to maximize eligible capture. We continuously monitor claims, flag compliance risks, identify workflow gaps, and surface revenue recapture through AI-powered assessments — so your team spends less time on manual compliance work and more time on program growth.
Data Integration
Integrates TPA and EHR data for comprehensive claims analysis and accurate eligibility determination.
Claims Monitoring
Continuously monitors all 340B claims, flags compliance risks, and detects duplicate discounts.
Revenue Recapture
Surfaces missed 340B claims and identifies referral leakage in real time for revenue recovery.
Compliance Reporting
Generates audit-ready reports for HRSA, ESP, and state-specific tracking automatically.
Capabilities
Comprehensive 340B program management
Patient Eligibility Determination
Track encounter, provider and patient relationship with Covered Entity to ensure eligibility to the 340B program.
Automated Compliance Audits
Proactively monitor all 340B claims data from TPA partners, identify non-compliant claims, detect duplicate discounts, and ensure HRSA and manufacturer requirements are continuously met.
Revenue Recapture Identification
Surface high-value missed 340B claims in real time.
Referral & Leakage Detection
Track and recover claims lost due to referral leakage. Analyses encounter, claims, and EHR data to reclassify overlooked referral-based eligibility, closing the loop on revenue drain.
Compliance Dashboards
Generate ready-to-deploy reports for HRSA audits, ESP, and state-specific tracking.
Impact
What this means for you
For the Health System
Maximize your 340B team’s output without increasing headcount
Recover revenue from TPA-rejected claims incorrectly classified as ineligible
Minimize leakage and contract pharmacy risk
Protect program status with continuous HRSA compliance monitoring
Reduce administrative burden for compliance audits
Automate review of 100% of 340B claims
Audit-ready reports generated automatically
Case notes and claim decisions tracked with full user history
Why Foundation Health
Why us
- Integrate TPA and EHR data in one place
- We connect the data sources your compliance team relies on, replacing manual cross-referencing with automated, continuous monitoring.
- Built for compliance
- The 340B program is the number one lobbying issue for hospital associations and losing status can threaten a health system’s ability to serve its community. We take that seriously.
- Recapture revenue
- Ensure your health system is not missing out on key 340B revenue recapture opportunities.
- Configurable to your program structure
- Whether your look-back period is 30 days or 12 months, and whether you work with one TPA or several, our platform adapts to your program rules and workflows.