Posts in AUDiT iQ
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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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
Millions Saved with Periodic Dependent Eligibility Audits
Millions Saved with Periodic Dependent Eligibility Audits

A previous audit by BMI led to the identification of over 100 ineligible dependents resulting in hundreds of thousands of dollars in savings.

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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”).

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Claims Audit Against Plan Design Reveals Inaccuracies
Claims Audit Against Plan Design Reveals Inaccuracies

To ensure the accuracy of claims payments compared against their plan design, and to identify any other opportunities for cost containment, this large manufacturing and service provider engaged BMI to audit medical claims paid by their third-party administrator (“TPA”).

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Audit Finding of the M..., AUDiT iQ, audit samples, BMI Audit Services, claim audit, claims administrator, claims audit, cost-containment solution, claims data, health care claims, health care benefits a..., health plan audit, Medical Claims Audits, retrospective audit, 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
Health Plan Fiduciary Duty Upheld Through Claims Audit
Health Plan Fiduciary Duty Upheld Through Claims Audit

A not-for-profit health system engaged BMI to audit medical claims paid by their third-party administrator (“TPA”) to demonstrate fiduciary responsibility over the plan’s administration to ensure benefits were being paid appropriately on behalf of plan participants.

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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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Audit Finding of the M..., AUDiT iQ, audit samples, claim audit, claims administrator, claims audit, claims data, BMI Audit Services, cost-containment solution, durable medical equpment, health care benefits a..., health care claims, health plan audit, Medical Claims Audits, payment errors, retrospective audit, Third-Party Administrator, TPA auditRobert Temples
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
Removal of Ineligible Dependents Saves Thousands
Removal of Ineligible Dependents Saves Thousands

To help combat rising health insurance costs, this food manufacturer and their employee benefit broker engaged BMI to verify whether or not the 1,475 enrolled dependents were eligible for health plan benefits.

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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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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, prescription drug clai..., retrospective audit, Self-Insurance Programs, Third-Party Administrator, TPA audit, Value ForwardRob Temples
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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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, 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 audit, Value ForwardRob Temples
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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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 Claims Audits, payment errors, retrospective audit, Third-Party Administrator, TPA audit, Value ForwardRob Temples
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