Announcing GFI Agent: Automatically Close the Loop on Missing MFP Refunds

Since Medicare's Maximum Fair Price (MFP) officially went live on January 1st, Plenful has helped customers manage and automate their MFP process, finding as much as 20% of expected MFP refunds missing.

For health systems running a high-volume pharmacy network, this can add up to hundreds of Good Faith Inquiries (GFIs) manually submitted every month. GFIs have to be filed within 120-days from the date of the dispute (835 remittance), making this a time-sensitive exercise.

Today, Plenful is announcing GFI Agent, a new capability within Plenful's MFP Intelligence solution designed to autonomously resolve duplicate or missing refunds.

Pharmacy teams can utilize GFI Agent to fully automate GFI submissions, as well as manage and complete the manufacturer requests connected to each GFI, such as providing specific invoices and associated claims to ESP.

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Without GFI Agent, the Good Faith Inquiry process creates a bottleneck for MFP refund reconciliation

If a MFP refund has been effectuated incorrectly, a GFI is the formal dispute used by pharmacies and covered entities to dispute the decision with drug manufacturers.

Filing a GFI means logging into Beacon's Resolution Center, navigating to the rebate details page for the rebate you want to contest, manually completing the step by step GFI wizard, and attaching the right supporting documentation. Pharmacy teams then wait for the manufacturer's response, one claim at a time.

Filing the GFI is only step one. Once a manufacturer responds, most ask for invoices and associated claims before approving the refund payment, an entirely separate process through the ESP reporting platform. That means locating the right purchase invoice, deciding what to share, submitting the requirements, and reconciling the subsequent 835 remittance. Without automation, this is all done manually, demanding hours of time as claim volume grows.

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GFI Agent allows pharmacy teams to recover every refund owed, without the manual chase

As a capability within MFP Intelligence, pharmacy teams work in one centralized system that handles the process end to end, from first inquiry to final payment.

With GFI Agent, pharmacy teams can:

• Automate the submission of GFIs directly in Beacon's Resolution Center for every eligible claim
• See denied GFIs flagged for review, with the manufacturer's rationale surfaced in Plenful’s task management UI
• Allow Plenful to locate and associate the purchase invoice tied to each claim via direct integrations with wholesaler EDI feeds
• Automatically submit details associated with GFIs to ESP, fully automated or with a human in the loop on invoice-claim review
• Track every submission against 835 remittance, updating as refunds are approved, denied, or still pending

Together, these capabilities give pharmacy, revenue cycle, and finance teams the full picture: which refunds are missing, which credits are outstanding, and which claims are still moving through resolution, without submitting, tracking, or reconciling a single one by hand.

Plenful customers live with GFI Agent are already saving weeks of time that would otherwise go to manual GFI submission and reconciliation, closing the loop on missing refunds with the speed the program's 120-day window demands.

GFI Agent is available as an addition to Plenful's MFP Intelligence solution, which automates reconciliation and increases visibility around MFP refunds to reduce the administrative burden on pharmacies.

Request a demo to see MFP Intelligence and GFI Agent in action and learn more about our entire suite of reconciliation management solutions, including Rebate Management.

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