Posts in ASO
Failure to Apply Appropriate Discounts Cost Employer $65k+
Failure to Apply Appropriate Discounts Cost Employer $65k+

Audit reveals $77,000+ in overpayments while reviewing just 245 sampled medical claims. A large portion of the findings (just over $66,000) were due to the TPA failing to apply appropriate discounts. As a result of the audit, the TPA has agreed to run impact reports which will identify additional claims with overpayments caused by this same issue.

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ASO, Audit Finding of the M..., AUDiT iQ, audit samples, BMI Audit Services, claim audit, claims administrator, claims audit, claims data, cost-containment solution, duplicate payments, ERISA, health care benefits a..., health care claims, health plan audit, internal audit department, Medical Claims Audits, payment errors, retrospective audit, Third-Party Administrator, TPA auditRobert Temples
Demonstration of Health Plan Fiduciary Duty Achieves Success
Demonstration of Health Plan Fiduciary Duty Achieves Success

A city government with 7,000 employees engaged BMI to conduct an independent audit of claims paid by their third-party administrator (“TPA”). The primary reason for the audit was to help demonstrate fiduciary responsibility over the plan’s benefits and expenses on behalf of participants

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ASO, Audit Finding of the M..., AUDiT iQ, audit samples, BMI Audit Services, claim audit, claims administrator, claims audit, claims data, cost-containment solution, ERISA, health care benefits a..., health care claims, health plan audit, internal audit department, Medical Claims Audits, payment errors, prior authorization, retrospective audit, Self-Insurance Programs, Third-Party Administrator, TPA auditRobert Temples