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340B Referral Captures for FQHCs

As if the 340B Program did not carry enough complexities and nuances already, the area of referral prescriptions comes with its own operational hurdles to navigate. The 1996 patient definition includes “referrals for consultation” within the mechanisms described for determining 340B patient eligibility. Over time, the inclusion of referral prescriptions in the 340B Program has become more widely adopted, and given more recent manufacturer restrictions, has become increasingly important in generating 340B resources to support safety net services.

Our referral capture service is designed to work with your organization to define patient eligibility in your 340B policy, in line with the 340B Statute, regulations, and guidance from the Office of Pharmacy Affairs. We will customize your referral policies and procedures to reflect your 340B Program’s unique operations and oversight. Our staff work to relieve the operational burden of processing referral prescriptions, allowing you to optimize 340B savings while ensuring compliance. Our goal is to bolster the success of your 340B Program, and pride ourselves on delivering this service at a fair cost, ensuring the value of the 340B savings remains with the health center.

Based on the health center's customized policy, our team of referral capture specialists review potentially eligible prescriptions each month. Prescriptions are assessed for the presence of necessary supporting documentation within the medical record, and where needed, the team will reach out to the specialist’s office on your behalf to obtain updated notes for inclusion within your medical record. When a claim is identified as eligible based on the health center's policy, documentation supporting the eligibility is recorded, and the claim is manually approved within the TPA. A monthly report is provided summarizing the claims that were qualified, including associated net financial impact to the organization.