Posts in prior authorization
Health Plan Inaccuracies Uncovered Through Claims Audit
Health Plan Inaccuracies Uncovered Through Claims Audit

A 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 More
Affordable Care Act, Audit Finding of the M..., AUDiT iQ, audit samples, BMI Audit Services, claim audit, claims administrator, claims audit, claims data, cost-containment solution, 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
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

Read More
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
Pharmaceutical Audit Reveals over $500,000 in Errors
Pharmaceutical Audit Reveals over $500,000 in Errors

This major metropolitan hospital engaged BMI to conduct a pharmaceutical audits of their prescription drug plan and pharmacy benefit manager (“PBM”) to ensure claims were being processed correctly.

Read More
Audit Finding of the M..., AUDiT iQ, audit samples, BMI Audit Services, claim audit, claims audit, cost-containment solution, drug exclusion, ERISA, health care benefits a..., health care claims, health plan audit, pbm, payment errors, pharmacy benefits manager, prescription drug clai..., prior authorization, retrospective audit, Self-Insurance Programs, systemic flawRobert Temples
Pre-Implementation Audit Prevents Costly Mistakes
Pre-Implementation Audit Prevents Costly Mistakes

This 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 More
Audit Finding of the M..., AUDiT iQ, BMI Audit Services, claims administrator, cost-containment solution, health care benefits a..., health care claims, health plan audit, internal audit department, Medical Claims Audits, pre-implementation audit, prior authorization, Self-Insurance Programs, Third-Party Administrator, TPA auditRobert Temples
Recurring Pharmaceutical Audit Continues to Prove Beneficial
Recurring Pharmaceutical Audit Continues to Prove Beneficial

For over 10 years, this large public school district has engaged BMI to conduct annual pharmaceutical audits of their prescription drug plans and pharmacy benefit manager (“PBM”).

Read More
Audit Finding of the M..., AUDiT iQ, audit samples, BMI Audit Services, claim audit, claims audit, claims data, cost-containment solution, health care benefits a..., health plan audit, health care claims, pbm, pharmacy benefits manager, payment errors, prescription drug clai..., prior authorization, re-enrollment auditRobert Temples
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.

Read More
Audit Finding of the M..., AUDiT iQ, audit samples, BMI Audit Services, 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, prior authorization, retrospective audit, 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”).

Read More
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.

Read More
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, health care claims, health care benefits a..., health plan audit, Medical Claims Audits, payment errors, prior authorization, retrospective audit, Third-Party Administrator, TPA auditRobert TemplesAudit Finding of the Month
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. 

Read More
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 and prescripti..., Medical Claims Audits, payment errors, prior authorization, retrospective audit, Sarbanes-Oxley, Self-Insurance Programs, Third-Party Administrator, TPA audit, Value ForwardRob Temples
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.

Read More
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, medical and prescripti..., Medical Claims Audits, payment errors, prescription drug clai..., prior authorization, Third-Party Administrator, TPA audit, Value ForwardRob Temples