An organization in the banking and financial industry asked BMI to verify the eligibility for 1,181 enrolled dependents on their medical plans. Previous checks by BMI in 2016 and 2019 resulted in the removal of 71 ineligible dependents, saving over $250,000.
Read MoreA city government was exploring several options to keep healthcare benefit costs from increasingly unnecessarily and engaged BMI to verify the eligibility of 1,495 dependents enrolled in the group’s health plans.
Read MoreA 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.
Read MoreA small manufacturer and exporter of recycled materials contacted BMI to verify the eligibility of 84 enrolled dependents on the group’s health plans.
Read MoreA statewide association of legal professionals contacted BMI to perform an audit of medical claims paid by their third-party administrator (“TPA”) and verify accuracy of claims paid on their behalf.
Read MoreThis transportation and logistics company periodically engages with BMI for dependent eligibility verification. Their previous audit was completed in 2017 and resulted in 180 dependents removed which equated to $630,000 in annual savings.
This most recent audit included the verification of 1,390 enrolled dependents to ensure there were no changes in eligibility and that all newly enrolled dependents were eligible for benefits.
Read MoreA large insurance pool of educators consisting of over 10,000 employees contacted BMI to perform an audit of claims paid by their third-party administrator (“TPA”). The primary reason for the audit was because the TPA moved to a new platform for claims processing and no prior audits were ever conducted.
Read MoreThis nationally recognized electronics and technology company engaged BMI to conduct a pharmaceutical audit of their prescription drug plan and pharmacy benefit manager (“PBM”) to ensure claims were being processed correctly.
Read MoreThrough regular collaboration with BMI, a municipal government has identified first-year savings totaling $775,000. Even with prior audits, the latest verification process resulted in savings of $375,000 with the discovery that 6.3% of enrolled dependents were not eligible for healthcare benefits.
Read MoreAudit 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.
Read MoreA 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
Read MoreAn automotive manufacturing facility looking to reduce unnecessary healthcare costs engaged BMI to verify whether any of the 1,057 employees enrolled were covering ineligible dependents.
Read MoreA 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.
Read MoreThis communications sector client with 3,500 employees approached BMI to conduct a pre-implementation audit after a segment of the company was carved out and paired with a new third-party administrator (“TPA”) for their health plans. The primary objective was to verify whether the new TPA’s system was set up appropriately according to each plan’s stated benefits.
Read MoreTo ensure only eligible dependents were enrolled for health benefits, this manufacturer engaged BMI to verify whether any of the 809 dependents were eligible according to plan eligibility requirements.
Read MoreAn 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.
Read MoreA manufacturer wanted to verify whether any of their 113 employees had enrolled a spouse who had other coverage available to them through employment. If so, the spouse would be ineligible for the manufacturer’s health plan through their “working spousal carve out” plan provision.
Read MoreAs a result of this medical claims audit, the plan’s TPA agreed to initial overpayment amounts exceeding $56,000 and has initiated refund processes. Manual processor error was given as the cause for many of the identified issues.
Read MoreSince 2011, this city government engages BMI to conduct biennial audits to verify the accuracy of medical claims paid by their third-party administrator (“TPA”).
Read MoreTo help combat rising health insurance costs, the internal audit department of a global engineering and manufacturing company engaged BMI to verify whether 511 enrolled dependents were eligible for the company’s medical and dental health plans.
Read More
