For many covered entities, the 340B program is a vital source of revenue that supports expanded services, outreach, and patient care. But too often, revenue losses go unnoticed until a compliance audit forces a closer look—by then, it's too late to recover what’s been lost.
At RxTrail, we believe in proactive management. Spotting revenue gaps early can be the difference between a thriving program and one that's just getting by. Here's how to stay ahead of the curve and protect your 340B savings—before any compliance issue ever arises.
1. Don’t Rely on Legacy Setups—Reassess Your TPA Filters Regularly
If your TPA configurations haven’t been reviewed in the last 6–12 months, it’s time. Covered entities change. Provider rosters, referral relationships, payer policies, and site statuses all evolve—and if your filters don’t reflect those changes, eligible claims may be slipping through the cracks.
We recommend a quarterly review to make sure your software is capturing all it should be, without excluding key accumulations.
2. Take a Fresh Look at Referral Capture
Referrals continue to be one of the most overlooked sources of lost savings. If your EMR isn’t documenting the full care continuum—especially when care crosses over multiple providers—you may be losing valid 340B claims.
We often see eligible prescriptions go unqualified because the EMR doesn’t clearly show the connection. Audit a few high-volume prescriptions and trace the patient’s path. You may be surprised by what you find.
3. Compare Replenishment Data Against Accumulated Claims
Are you getting the drugs you paid for? Compare TPA accumulation reports to wholesaler invoices. We’ve seen covered entities miss out on thousands in savings due to mismatches between what was accumulated and what was actually replenished.
Some gaps are due to price tier issues, wholesaler NDC availability, or even timing mismatches between order and accumulation. They’re not always easy to catch—but they’re fixable.
4. Get Ahead of Medicaid Carve-In Confusion
For sites billing Medicaid or MCOs, one of the most common areas of revenue loss comes from improperly configured carve-in statuses. If your carve-in status in OPAIS isn’t up to date—or if your TPA is applying overly cautious filters—you could be missing out on entire classes of eligible claims.
We keep close tabs on Medicaid billing requirements by state and can help you fine-tune configurations to avoid duplicate discounts without over-filtering your revenue.
5. Know When It’s Time to Bring in a Fresh Set of Eyes
You know your operations best. But that familiarity can sometimes make it harder to spot issues hiding in plain sight. A quick revenue review from a consulting partner like RxTrail can uncover blind spots, offer insight into new capture opportunities, and even spot compliance risks before they escalate.
Whether you need a one-time review or ongoing monitoring, we’re here to make sure your program performs the way it should—so you can focus on your patients, not on patching holes in your data.
Your 340B program should be a dependable source of revenue and impact—not a guessing game. At RxTrail, we help you keep your program clean, compliant, and optimized for performance—so you’re never caught off guard.
Ready to take a closer look? Schedule a call with our team
