#United States #San Francisco #Plenful #GFI Agent #MFP Refunds

Plenful Introduces the GFI Agent

A New Solution for Pharmacy Teams

Plenful, a top AI workflow automation platform dedicated to improving pharmacy operations, recently introduced the GFI Agent. This innovative tool aims to automate processes surrounding missing Medicare Maximum Fair Price (MFP) refunds, a significant concern for pharmacy teams managing numerous claims. The GFI Agent is a part of the larger MFP Intelligence solution and addresses issues related to duplicate or missing refunds with efficiency and ease.

The Challenge of Missing Refunds

Since the launch of Medicare's MFP policy on January 1st, Plenful has identified that as much as 20% of expected refunds were missing. For health systems that run busy pharmacy networks, this can lead to hundreds of Good Faith Inquiry (GFI) submissions each month, often made manually. Unfortunately, GFIs must be submitted within 120 days of a dispute, creating a process that is not only labor-intensive but also highly time-sensitive. The sheer volume of claims only exacerbates this challenge, requiring hours of administrative effort when handled manually.

Automation with GFI Agent

The GFI Agent revolutionizes this process by allowing pharmacy teams to automate GFI submissions, manage necessary manufacturer requests, and effectively navigate the entire refund system without manual tracking. Key features of the GFI Agent include:

• - Automated GFI Submission: Automatically submits eligible GFIs directly through Beacon's Resolution Center.
• - Denial Management: Flags denied GFIs for review, displaying the manufacturer's reasoning through Plenful's task management interface.
• - Invoice Association: Integrates directly with wholesaler EDI feeds to quickly locate and associate relevant purchase invoices.
• - ESP Submission: Processes related GFI details to ESP, either completely automated or with human oversight when necessary.
• - Real-time Tracking: Allows teams to monitor each submission against 835 remittance, keeping them updated on the status of refunds, whether they are approved, denied, or still pending.

These advancements provide utilized pharmacy, revenue cycle, and finance teams with full visibility into which refunds haven’t been received and which claims are still in process, eliminating the need for manual handling or tracking of submissions.

Delivering Efficiency and Saving Time

Pharmacy teams already employing the GFI Agent report saving weeks of time annually that was previously devoted to manual keying and reconciliation of GFIs. As Joy Liu, founder and CEO of Plenful, highlighted, “Every month, pharmacy teams are filing hundreds of Good Faith Inquiries by hand, one claim at a time, just to recover money they're already owed.” With the GFI Agent, pharmacy teams can gain insights into missing refunds and automate the submission process instead of addressing each claim individually.

The Impact of GFI Agent

Plenful’s GFI Agent within the MFP Intelligence solution is designed to enhance operational efficiency and reduce administrative burdens on pharmacy teams significantly. The time saved from automation can instead be directed towards more strategic activities, thereby improving overall operational effectiveness in healthcare settings.

If you want to discover more about how Plenful's reconciliation management solutions can streamline operations, including their Rebate Management capabilities, visit Plenful.com.

Conclusion

As the healthcare landscape continues to evolve, tools like the GFI Agent represent the future of pharmacy operations. By leveraging intelligent automation, Plenful is helping pharmacy teams focus on patient care rather than paperwork, ultimately moving the pharmacy industry toward a more efficient and resilient operational framework.