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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Looking to help combat rising health insurance costs, a construction company with 159 employees approached BMI to confirm that only eligible dependent children and spouses were enrolled in the company’s health plans.
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Since 2011, this city government engages BMI to conduct biennial audits to verify the accuracy of medical claims paid by their third-party administrator (“TPA”).
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A school district with 259 employees approached BMI to conduct a dependent eligibility audit after discovering that an employee’s ex-spouse was incurring costs on their health plans.
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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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A manufacturer with 358 employees approached BMI to conduct a dependent eligibility audit after suspecting ineligible dependents were enrolled on the plan causing costs to increase unnecessarily.
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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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A national retailer with 470 employees approached BMI to conduct a review of dependent coverage elected by plan participants and to validate whether enrolled dependents met the plan’s eligibility requirements.
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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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After merging two companies into one benefit plan offering, this food and beverage company engaged BMI to verify whether 329 enrolled dependents were eligible for the company’s health plans.
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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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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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To help combat rising health insurance costs, the internal audit department of a global engineering and manufacturing company engaged BMI to verify whether 511 enrolled dependents were eligible for the company’s medical and dental health plans.
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To help combat rising health insurance costs, this electric motor manufacturer and their employee benefits broker engaged BMI to verify whether 3,425 enrolled dependents were eligible for health plan benefits.
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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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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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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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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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This client’s employee benefits broker approached BMI for reassurance of proper plan adjudication after their third-party administrator reimbursed the group for errant claim payments.
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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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