A manufacturer wanted to verify whether any of their 113 employees had enrolled a spouse who had other coverage available to them through employment. If so, the spouse would be ineligible for the manufacturer’s health plan through their “working spousal carve out” plan provision.
Read MoreAs 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.
Read MoreLooking 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.
Read MoreSince 2011, this city government engages BMI to conduct biennial audits to verify the accuracy of medical claims paid by their third-party administrator (“TPA”).
Read MoreA 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.
Read MoreThe 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 MoreA 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.
Read MoreA client within the healthcare sector approached BMI to conduct a pre-implementation audit after deciding to consolidate two different existing plans with a single third-party administrator (“TPA”) in order to verify whether the TPA’s system was set up appropriately according to each plan’s benefits.
Read MoreA previous audit by BMI led to the identification of over 100 ineligible dependents resulting in hundreds of thousands of dollars in savings.
Read MoreA 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 MoreTo 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”).
Read MoreA 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.
Read MoreA 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.
Read MoreA client within the financial services industry approached BMI to conduct a pre-implementation audit after moving to a new carrier. Their primary objective was to verify whether the carrier’s system was set up appropriately to administrate their claims according to plan benefits.
Read MoreTo 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.
Read MoreA 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 MoreA leading global medical technology company engaged BMI to audit medical claims paid by their third-party administrator as part of their due diligence efforts.
Read MoreThis 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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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.
Read MoreAt 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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