A New Value Forward Approach to Auditing Proves Successful.

Business Situation

This client conducts a periodic claims audit of their administrator for their self-insured medical plans every 2-3 years.  This latest audit included BMI’s new Value Forward approach.

Audit Finding

BMI identified the following types of errors using a combination of our proprietary software AUDiT iQ™ to review of 100% of the claims and our auditor’s expertise to choose sample selections to review on-site.

  • Incorrect application of copay

  • Payment for non-medically necessary services

  • Duplicate payments

  • Payments made for excluded services based on internal policy vs. specific plan language

Third-Party Administrator Response

Initially and not uncommon with previous audits with the client, the administrator agreed to 4 duplicate claims totaling $3,600 and challenged numerous other audit findings.

Audit Outcome

At the conclusion of the audit BMI assigned a Post-Audit Support Coordinator to walk the client through the audit findings and provide steps to obtain resolution to the identified errors. After several rounds of communication with all parties involved coordinated by BMI, the administrator credited the client over $40,000 for benefits paid in direct conflict with plan language. The administrator was so complementary of process BMI used that they agreed to make adjustments in audit handling with other clients.

In addition to errors identified directly through the audit, BMI’s analysis of plan designs and claims data identified an additional $300,000 in potential future savings by making suggested plan language revisions.

This client realized a direct and indirect ROI of over 1,200% through BMI’s new Value Forward approach.

Audit Finding of the M..., BMI Audit Services, claim audit, Third-Party Administrator, Value ForwardRandy Light, Founder + Executive Advisor