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340b Assistance for TPA’s

340B Assistance for
TPAs

Cooper Strategy helps 340B TPA vendors and Covered Entities build audit‑ready, high‑yield programs. We don’t sell a TPA; we strengthen the one you have—or help you select the best 340B TPA for your environment—and then harden the data, rules, and documentation so compliance is baked in.

Under HRSA’s contract‑pharmacy notice, the Covered Entity (CE) remains accountable for preventing diversion and duplicate discounts and for maintaining auditable records—and HRSA expects annual independent audits. Our job is to make those expectations easy to meet.

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What We Do for TPAs & CE/TPA Teams

01

Implementation & Data Engineering

  • Map identifiers (NPI, NCPDP/NABP, prescriber/location status), encounter logic, and virtual inventory/replenishment rules
  • Harden accumulators, claim matching, and exception queues
  • Enforce "ship-to/bill-to" documentation
02

Medicaid Duplicate-Discount Controls (FFS & MCO)

  • Align Medicaid Exclusion File (MEF) carve-in strategies for fee-for-service Medicaid
  • Build state-specific flags for managed care where MEF doesn't apply
  • Reconcile claims and rebate data to catch collisions before invoicing
03

Patient Definition & Eligibility Proof

  • Configure evidence chains (referral orders, encounter notes, prescriber/location eligibility)
  • Ensure dispensing isn't the only service documented
  • Match HRSA's audit posture on patient definition
04

Orphan-Drug Logic (Where It Applies)

  • For hospital types subject to the orphan-drug exclusion (RRC, SCH, CAH, free-standing cancer)
  • Implement indication-sensitive rules and audit logs
05

Audit-Ready by Design

  • Build a one-click audit bundle (logs, transactions, eligibility proofs)
  • Prepare for HRSA/manufacturer reviews and your independent auditor
  • Consistent with HRSA's expectation of independent outside audits
06

Walgreens Referral-Capture Integration

  • Cooper Strategy is one of only two sources CEs can use for Walgreens referral-capture assistance
  • Wire referral data into your TPA workflows
  • Raise qualified capture and cut manual rework
07

TPA Selection & Migration

  • Vendor-neutral RFP scoring (data model, pharmacy network fit, Medicaid logic, reporting)
  • Migration playbooks with parallel validation and regression tests
  • Keep reconciliation clean
08

Security & Governance

  • HIPAA BAAs, SFTP/API integration, PHI minimization
  • Role-based access
  • CE/TPA SOPs that mirror HRSA's auditable records and duplicate-discount requirements

What "Best 340B TPA" Really Means

There is no one "best" across all settings. We evaluate fit for your mix of entity types, state Medicaid rules, contract-pharmacy footprint, specialty/mail-order needs, and reporting depth. The right choice is the one that maximizes compliant capture with the least operational drag—then proves it at audit time.

Core evaluation dimensions:
Eligibility engine (patient, prescriber, location), referral handling, and MEF/MCO logic
Accumulator design and inventory/replenishment transparency
Orphan-drug rule handling (for applicable hospitals)
Audit trails, exportability, and independent-audit support

How We Work With TPA 340B Companies (Collaborative, Not Competitive)

We operate as your force multiplier: we clean data at the source, tune rule logic, close documentation gaps, and reduce exception noise—so TPAs run faster and CEs feel confident. HRSA's 2010 notice is clear: the CE is accountable, but a well-instrumented CE/TPA partnership makes that accountability straightforward to demonstrate.

KPIs We Track With You

  • Eligible-to-captured rate
  • Reversal/exception rates and drivers
  • Days-to-replenish & days-to-reconcile
  • Medicaid duplicate-discount collisions avoided (FFS/MCO)
  • Audit pack completeness & time-to-produce

Common Pitfalls We Fix

"Dispensing-only" documentation with no qualifying encounter evidence
Carve-in misalignment (MEF identifiers don't match claim billing)
Orphan-drug misclassification for hospital types under the exclusion
Thin audit trails that don't meet HRSA expectations for independent review

Why Cooper Strategy

  • Vendor-neutral partner to 340B TPA vendors and CEs
  • AI + expert double-review on claims (fewer reversals, cleaner reconciliations)
  • Walgreens referral-capture access to lift eligible script capture
  • Audit-ready tech: one-click bundles for CFOs, CE teams, and auditors
  • Mission-driven: maximize savings to reinvest in underserved communities
Compliance note: Program integrity requires CEs to keep OPAIS records current and to register contract pharmacies and child sites appropriately—another reason to keep CE/TPA data in lockstep.

Ready to Take the Next Steps

  • Request a TPA Readiness Review → rules engine, MEF/MCO logic, audit trails.
  • Schedule a Duplicate-Discount Workshop → carve-in/out design and testing.
  • Ask for Our Vendor-Neutral RFP Matrix → pick the "best 340B TPA" for your needs.

Resources

340B Optimization, Referral Capture & Compliance

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340B for Hospitals & Health Centers

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340B for Pharmacies

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340B for Government

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We're a TPA-agnostic 340B partner that turns complex rules into clean data, compliant logic, and audit-ready documentation—so CEs and 340B TPA companies can focus on patient impact.