Posts in medical and prescripti...
Claims Audit Reveals Underlying Issues
Claims Audit Reveals Underlying Issues

The TPA agreed to initial overpayment amounts exceeding $5,000, however, further investigation of claims samples by the TPA revealed an additional $150,000 in errant claims outside of those sampled through the audit.

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Trust, but Verify – Annual Claims Audit Finds Mistakes Continue
Trust, but Verify – Annual Claims Audit Finds Mistakes Continue

This organization engages BMI to conduct annual audits of medical claims paid by their third-party administrator to ensure claims are continuing to be paid correctly following their last audit.

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Audit Finding of the M..., BMI Audit Services, AUDiT iQ, audit samples, claim audit, claims administrator, claims audit, claims data, cost-containment solution, health care benefits a..., health care claims, health plan audit, medical and prescripti..., Medical Claims Audits, payment errors, retrospective audit, Self-Insurance Programs, Third-Party Administrator, TPA auditRobert Temples
Medical & Rx Audit Yields Big Savings for Employer Group
Medical & Rx Audit Yields Big Savings for Employer Group

At the recommendation of their consultant following concerns about the accuracy of claims adjudication, this employer group approached BMI to conduct an audit of medical and prescription drug claims paid by their third-party administrator. 

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Comprehensive Audit of Medical Claims Uncovers Errors
Comprehensive Audit of Medical Claims Uncovers Errors

In support of due diligence efforts, a construction industry health and welfare fund approached BMI to conduct a comprehensive audit of 24 months of medical claims paid by their third-party administrator. 

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Claims Audits Test Third-Party Administrator Effectiveness
Claims Audits Test Third-Party Administrator Effectiveness

Every few years this large group of public school districts relies on BMI to conduct a thorough review of medical claims paid by their third-party administrator to ensure the plan’s assets are being used appropriately for the sole benefit of plan participants. 

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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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Claims Audits – An Immediate and Future Cost Reduction Strategy
Audit Finding of the M..., AUDiT iQ, audit samples, BMI Audit Services, claim audit, claims administrator, claims audit, claims data, cost-containment solution, drug exclusion, duplicate payments, eligibility, eligible dependent, health care benefits a..., health care claims, health plan audit, medical and prescripti..., Medical Claims Audits, payment errors, pbm, pharmacy benefits manager, plan eligibility, prescription drug clai..., retrospective audit, Third-Party Administrator, TPA audit, Value ForwardRob Temples