Posts in systemic flaw
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.

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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
Adjudication Inaccuracies Uncovered Through Claims Audit
Adjudication Inaccuracies Uncovered Through Claims Audit

As 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.

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Audit Finding of the M..., audit samples, BMI Audit Services, AUDiT iQ, 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, retrospective audit, Self-Insurance Programs, systemic flaw, Third-Party Administrator, TPA auditRobert Temples
Claims Audit Reveals Plan Build Mistakes and Processor Errors
Claims Audit Reveals Plan Build Mistakes and Processor Errors

A large manufacturer engaged BMI to audit medical claims paid by their third-party administrator (“TPA”) after concerns were raised about whether certain claims were being paid appropriately.

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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, ERISA, health care benefits a..., health care claims, health plan audit, Medical Claims Audits, payment errors, retrospective audit, Third-Party Administrator, systemic flaw, TPA auditRobert Temples