Services

As part of a growing trend to protect themselves from fraud and ensuring their legal, fiduciary and fiscal duties, many employers have turned their attention towards verifying the appropriateness of their health care expenditures. Many external auditors have recommended formalizing and strengthening theses controls in response to federal regulations by ERISA and Sarbanes-Oxley. BMI offers the following services:

HEALTH CARE CLAIMS AUDITS

Combining advanced technology with time-tested audit methodologies, BMI has developed an innovative approach to assessing health care claims administrative effectiveness. Our unique audit methodology is efficient and cost-effective; focusing on opportunities for corrective action while not ignoring opportunities for recovery of errant payments. Detailed and easy-to-use reports are prepared by BMI and serve as the foundation for the development of realistic, practical, and cost-saving solutions.

Medical Claims

We employ computer aided systems, human logic, and onsite reviews to efficiently identify claims with the highest likelihood for improper payments. By virtue of identifying such claims, other administrator issues and/or weaknesses are uncovered, such as system limitations, plan build inaccuracies, overuse of processor overrides, and provider billing errors.

Prescription Drug Claims

BMI’s use of nationally-recognized drug databases, along with internally developed clinical and technical logic, provides unparalleled checks against improper payments and administrative oversights.

Dental Claims

Audit criteria includes exceptions to covered services, services provided to ineligible participants, timely filing limits, deductible application, coinsurance application, and maximum benefits.

DEPENDENT ELIGIBILITY AUDITS

Depending on employee demographics and complexity of the eligibility criteria, as many as 3-12% of covered dependents may be ineligible. By eliminating these ineligible dependents, employers can realize considerable savings in claims, premiums, administration fees, and other possible plan costs.

BMI understands the sensitive nature of the relationship between employers and their employees. BMI’s flexible approach to verifying dependent eligibility provides the employer with many options by which to communicate the necessity of the audit.

Comprehensive Method

The Comprehensive Method includes all covered dependents and provides the strongest level of assurance that only eligible dependents are enrolled in the plan.

Focused Method

The Focused Method concentrates on covered dependents who may have circumstances indicating potential anomalies. The amnesty program can be offered in conjunction with this approach and provides enrolled employees an opportunity and incentive to voluntarily remove ineligible dependents.

WORKERS COMPENSATION CLAIMS COST ANALYSIS

To help reduce and prevent rising workers compensation costs, our experienced staff will customize a plan for your company’s specific needs by identifying opportunities to reduce claim frequency and severity.

With a claims management program tailored to your specific needs, you can reduce your costs, improve safety awareness, and save time.

Using complex and confusing reports you or your insurance agent already receive, we analyze the information exhaustively and report it to you in an easy-to-use format.

Loss Report Analysis

We analyze your current and past claims history and report detailed results to you in an easy-to-read format. Comprehensive reports and graphs help you understand frequency, severity, average claim costs, and specific large losses, and their long-term impact on your experience modification.

Injury Trending

We assign an injury body part, injury type, and injury cause to each claim and identify the leading contributors in each category. Other trending reports can identify claims by day, month, location, department, and even shift based on the information provided to us.

Experience Modification Rating Analysis

Using experience modification rating software, we recreate your current rating, calculate your lowest possible rating, and determine the impact of specific large claims on your controllable rating. Additional analysis can include scenarios to illustrate the savings from “medical only” to “lost-time” claims.