Introducing Referral Agent, the First Agent Built for 340B Referral Capture

Today we’re announcing Referral Agent - the first AI agent purpose-built for 340B referral capture. At a leading Mid-Atlantic academic medical center, Referral Agent expanded referral claim review from 130 claims per month to 12,700 - a 98x capacity increase. At more than $1,850 in average 340B savings recaptured per claim, the impact compounds with every future fill.

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A savings opportunity too cost-prohibitive to pursue

For most covered entities, referral capture is one of the largest untapped savings opportunities within 340B, and one of the hardest to operationalize. The challenge is structural. Referral evidence doesn't live in one place. It's buried in clinical notes, free-text fields, and faxes scattered across multiple systems. Traditional third-party administrator (TPA) matching logic only surfaces discretely coded data, leaving the majority of real-world referral evidence undiscovered. Manual chart review is expensive, inconsistent, and impossible to scale across the thousands of claims large health systems process each month. Most programs have never attempted a systematic referral capture strategy — the operational lift is simply too high.

Plenful’s Referral Agent finds what manual processes and TPAs miss

Plenful's Referral Agent acts as a force multiplier for 340B teams. Using large language models (LLMs) trained on clinical language, the agent analyzes both structured and unstructured EHR data - including clinical notes, PDFs, and other documentation - to find referrals and match them to downstream claims. FHIR integration simplifies secure access to patient data across systems, eliminating the friction of traditional data extraction. To close the documentation loop, Referral Agent automatically generates referral documentation back to the referring provider via major EHRs - giving pharmacy teams a defensible, HRSA-ready evidence record for every captured referral.

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For external referrals where encounter data lives outside the EHR, Referral Agent traces prescription claims, recovering scripts that would otherwise remain invisible to covered entities.

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Plenful’s Referral Agent enables pharmacy teams to:

• Uncover millions in missed 340B savings. Recover referral-based claims that manual processes couldn't reach. With average recapture exceeding $1,850 per claim, and covered entities reviewing thousands of claims per month, the impact adds up quickly.
• Significantly scale referral review. Automate the scanning of clinical notes, summaries, and PDFs to uncover referral evidence that’s often missed by manual review. At a leading Mid-Atlantic academic medical center, Referral Agent expanded referral claim review from 130 claims per month to 12,700 - a 98x capacity increase.
• Act on ranked, high-confidence findings. Prioritize flagged claim review by drug cost and referral specialty to optimize for high-value work, with an 82% accuracy rate on flagged claims.
• Closed-loop Referral Documentation. Automatically generate and send referral documentation back to the referring provider via major EHRs. Referral Agent closes the documentation loop, building a defensible, HRSA-ready evidence record for every captured referral.
• Gain visibility into external referrals. Trace contract pharmacy claims to attribute referrals that exist entirely outside the health system's EHR.

From cost-prohibitive to a scalable path

"One of our partners went from reviewing 130 referral claims a month to 12,700 — not by adding staff, but by letting AI do the work that was never possible to do manually. Most 340B programs weren't running a referral capture strategy at all — not because the savings weren't real, but because finding informal referrals buried in clinical notes is an infinite task," said Joy Liu, Founder and CEO of Plenful. "Referral Agent changes the equation entirely. It expands what your team can pursue beyond formal orders alone and makes a strategy that was too cost-prohibitive to run manually not just possible, but scalable."

Referral Agent expands Plenful’s 340B Audit & Optimization suite, which supports more than 95 health systems nationwide. To learn more about Plenful’s AI workflow automation platform for 340B optimization, revenue optimization, and intake authorization solutions for infusion and specialty pharmacy teams, visit Plenful.com.