Posts in health care claims
Annual Pharmaceutical Audit Uncovers Systemic Errors
Annual Pharmaceutical Audit Uncovers Systemic Errors

This large county government engages BMI to conduct annual pharmaceutical claims audits of their self-insured pharmaceutical plan and pharmacy benefit manager (PBM). In addition, the client also engaged BMI to conduct a contractual financial guarantee audit.

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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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Claims Audit Uncovers Thousands in Manual Errors
Claims Audit Uncovers Thousands in Manual Errors

A leading global medical technology company engaged BMI to audit medical claims paid by their third-party administrator as part of their due diligence efforts.

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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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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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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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