Posts in duplicate payments
Claims Audit Confirms Questionable TPA Accuracy
Claims Audit Confirms Questionable TPA Accuracy

A statewide professional organization in the banking industry contacted BMI after catching several medical claims processing errors by their third-party administrator (“TPA”).  Since these mistakes were stumbled upon by accident, a request for a full claims audit was made to ensure all claims were being paid appropriately under the plan.

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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, health care benefits a..., health care claims, health plan audit, internal audit department, Medical Claims Audits, payment errors, retrospective audit, Self-Insurance Programs, Third-Party Administrator, TPA auditRobert Temples
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
Claims Audit Confirms Employer’s Suspicions of TPA Accuracy
Claims Audit Confirms Employer’s Suspicions of TPA Accuracy

A statewide association of financial institutions engaged BMI to conduct an audit of their member’s medical claims paid by their third-party administrator (“TPA”). The association reported higher than expected costs and claimant activity with suspicion of various claims processing issues. 

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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, health care benefits a..., health care claims, health plan audit, internal audit department, Medical Claims Audits, payment errors, retrospective audit, Self-Insurance Programs, systemic flaw, Third-Party Administrator, TPA auditRobert Temples
Claims Audit Confirms COVID-19 Claim Adjudication Suspicions
Claims Audit Confirms COVID-19 Claim Adjudication Suspicions

An engineering firm with over 7,000 employees engaged BMI to conduct of medical claims adjudicated by their third-party administrator (“TPA”) after suspecting some COVID-19 claim related expenses were incorrect.

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Audit Finding of the M..., AUDiT iQ, audit samples, BMI Audit Services, claim audit, claims administrator, claims audit, claims data, cost-containment solution, CPT code, duplicate payments, ERISA, health care benefits a..., health care claims, health plan audit, internal audit department, payment errors, retrospective audit, Self-Insurance Programs, Third-Party Administrator, TPA auditRobert Temples
Subsequent Claims Audit Reveals Systemic Issues Continued
Subsequent Claims Audit Reveals Systemic Issues Continued

A large supermarket chain engaged BMI to verify whether issues uncovered in their last medical claims audit were ultimately fixed by their third-party administrator (“TPA”).

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Audit Finding of the M..., audit samples, AUDiT iQ, BMI Audit Services, claim audit, claims administrator, claims audit, claims data, cost-containment solution, duplicate payments, health care benefits a..., health care claims, health plan audit, Medical Claims Audits, payment errors, prior authorization, retrospective audit, Self-Insurance Programs, Third-Party Administrator, TPA auditRobert Temples
Move to Self-Insured Medical Plan Prompts Beneficial Audit
Move to Self-Insured Medical Plan Prompts Beneficial Audit

A nationally recognized mobile application developer engaged BMI to audit medical claims paid by their third-party administrator (“TPA”) after moving to self-insured and making several plan design changes.

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Savings Follow Audit of Client’s Third-Party Administrator
Savings Follow Audit of Client’s Third-Party Administrator

BMI was engaged to audit this manufacturer’s new third-party administrator for both their medical and prescription drug plans to ensure benefits were being paid appropriately and to evaluate overall administrative effectiveness.

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Medical Claims Audit Yields Significant Cost Recovery
Medical Claims Audit Yields Significant Cost Recovery

This city government approached BMI to conduct a retrospective audit of medical claims following concerns about proper adjudication.

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Claims Audits – An Immediate and Future Cost Reduction Strategy
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