Start with one program. Reconcile dispensing, eligibility, and finance data; prove tightened compliance and protected sa
Our 340B savings are leaking to manufacturer restrictions an
You can pilot reconciliation across EHR/pharmacy/finance for one program without a TPA switch.
What changes when AI orchestration runs the loop
Not 'another 340B add-on' -> 'close the reconciliation gaps your TPA leaves exposed to clawback.'
You've got a TPA; the EHR/pharmacy/finance reconciliation gaps still drive audit risk. A model that reconciles across systems and assembles documentation closes the gap generic tools leave.
Not 'more split-billing rules' -> 'clear the reconciliation exceptions your platform can't.'
You've got split-billing software; exception reconciliation across fragmented data stays manual. A model trained on your reconciliation decisions clears the matches and flags real exceptions.
Not 'more rules' -> 'prove the controls operate, not just that rules exist.'
You apply rules; validating they work in practice is manual. A model trained on your control decisions evidences operation and assembles the HRSA-ready trail - so a CAP reflects real remediation.
Not 'more TPA logic' -> 'find why a claim was missed or wrongly captured, traced to source.'
You've got TPA reporting; diagnosing discrepancies across misaligned feeds is manual. A model trained on your data relationships traces each discrepancy to root cause across EHR/pharmacy/TPA.
Where the work changes
Five frames in this vertical's language — leak, operational, governance, analysis, growth.
Leak / value-capture: Not 'another 340B add-on' -> 'close the reconciliation gaps your TPA leaves expo
Our 340B savings are leaking to manufacturer restrictions and we're one audit gap from clawback.
- Manufacturer contract-pharmacy restrictions erode savings; savings at risk industry-wide.
- HRSA audit exposure for duplicate discounts, diversion, eligibility documentation.
- Data-integration gaps between EHR, pharmacy dispensing, and finance create audit vulnerability.
- Administrative strain as audit requests and reporting requirements increase.
Operational throughput: Not 'more split-billing rules' -> 'clear the reconciliation exceptions your plat
Every cycle we hand-reconcile 340B vs non-340B dispensing across systems that don't talk to each other.
- Manual reconciliation across fragmented EHR / pharmacy / finance / wholesaler data each cycle.
- Monthly/quarterly purchase-vs-dispense reconciliation is recurring high-volume throughput work.
- Fragmentation + manual workflows drive the compliance-exception load (duplicate discount, diversion).
- Audit-ready trail must be assembled by hand from disconnected systems.
Governance & audit: Not 'more rules' -> 'prove the controls operate, not just that rules exist.'
An unannounced HRSA audit can demand proof my duplicate-discount and diversion controls work, and I can't produce a validated, current trail.
- HRSA audits (~200 covered entities/yr) demand validated internal controls against duplicate discount & diversion.
- Adverse findings -> mandatory repayment to manufacturers; in extreme cases program removal.
- Findings driven by documentation gaps, outdated policies, and controls 'not validated in practice.'
- Filing a CAP without genuine remediation leads to re-audit failure.
Analysis / diagnosis: Not 'more TPA logic' -> 'find why a claim was missed or wrongly captured, traced
My true 340B capture is hidden in discrepancies between TPA feeds, EHR, and pharmacy data that interpret eligibility differently - diagnosing why a claim was missed or wrongly captured means tracing i
- Multiple TPAs apply different logic and inconsistent data feeds - causing both missed eligible claims and false inclusions.
- Diagnosing the true capture rate means comparing total claims processed vs those captured under 340B, across sources.
- Misaligned systems produce discrepancies that are hard to trace to root cause.
- Under the 2026 rebate model, every claim-level discrepancy is financially consequential (denials, repayment).
Where current tooling falls short
Category limitation: TPAs and split-billing tools handle qualification mechanics but reconciliation across fragmented EHR/pharmacy/finance data - the root of audit failures - remains weak; compliance judgment and documentation assembly stay labor-bound under rising audit volume.
What's leaking and what it costs
Frequently asked
Still have questions?
Book a 25-min callAn unannounced HRSA audit can demand proof my duplicate-discount and diversion controls work, and I can't produce a validated, current trail. Not 'more rules' -> 'prove the controls operate, not just that rules exist.'