A manufacturer with 270 employees engaged BMI to verify whether any of the 688 enrolled dependents met the plan’s eligibility and spousal surcharge criteria.
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An engineering firm with over 7,000 employees engaged BMI to conduct of medical claims adjudicated by their third-party administrator (“TPA”) after suspecting some COVID-19 claim related expenses were incorrect.
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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.
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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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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 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.
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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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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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This healthcare organization relied on BMI for ongoing dependent eligibility audits to help manage eligibility and spousal surcharge verification in circumstances such as life events or new hires. This independent expert verification can prevent ineligible dependents from continuing to enroll in the plan while reducing an employer’s administrative burden.
An initial audit by BMI led to the removal of over 1,000 dependents and annual savings of over 4 million dollars.
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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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A 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.
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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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