This transportation and logistics company periodically engages with BMI for dependent eligibility verification. Their previous audit was completed in 2017 and resulted in 180 dependents removed which equated to $630,000 in annual savings.
This most recent audit included the verification of 1,390 enrolled dependents to ensure there were no changes in eligibility and that all newly enrolled dependents were eligible for benefits.
Read MoreA large insurance pool of educators consisting of over 10,000 employees contacted BMI to perform an audit of claims paid by their third-party administrator (“TPA”). The primary reason for the audit was because the TPA moved to a new platform for claims processing and no prior audits were ever conducted.
Read MoreAn electrical and telecommunication distributor contracted with BMI to ask employees to provide documentation to verify the eligibility of their 728 enrolled dependents on the group’s health plans.
Read MoreThis nationally recognized electronics and technology company engaged BMI to conduct a pharmaceutical audit of their prescription drug plan and pharmacy benefit manager (“PBM”) to ensure claims were being processed correctly.
Read MoreThrough regular collaboration with BMI, a municipal government has identified first-year savings totaling $775,000. Even with prior audits, the latest verification process resulted in savings of $375,000 with the discovery that 6.3% of enrolled dependents were not eligible for healthcare benefits.
Read MoreAudit reveals $77,000+ in overpayments while reviewing just 245 sampled medical claims. A large portion of the findings (just over $66,000) were due to the TPA failing to apply appropriate discounts. As a result of the audit, the TPA has agreed to run impact reports which will identify additional claims with overpayments caused by this same issue.
Read MoreA city government with 7,000 employees engaged BMI to conduct an independent audit of claims paid by their third-party administrator (“TPA”). The primary reason for the audit was to help demonstrate fiduciary responsibility over the plan’s benefits and expenses on behalf of participants
Read MoreAn automotive manufacturing facility looking to reduce unnecessary healthcare costs engaged BMI to verify whether any of the 1,057 employees enrolled were covering ineligible dependents.
Read MoreThis major metropolitan hospital engaged BMI to conduct a pharmaceutical audits of their prescription drug plan and pharmacy benefit manager (“PBM”) to ensure claims were being processed correctly.
Read MoreA food and beverage retailer with 709 employees engaged BMI to verify whether any of the 1,383 enrolled dependents met the plan’s eligibility and spousal surcharge criteria.
Read MoreA statewide association of financial institutions engaged BMI to conduct an audit of their member’s medical claims paid by their third-party administrator (“TPA”). The association reported higher than expected costs and claimant activity with suspicion of various claims processing issues.
Read MoreA large regional hospital with over 1,200 employees engaged BMI to verify if 2,643 enrolled dependents were eligible according to plan eligibility requirements. Their last dependent verification audit was conducted over 5 years ago.
Read MoreThis communications sector client with 3,500 employees approached BMI to conduct a pre-implementation audit after a segment of the company was carved out and paired with a new third-party administrator (“TPA”) for their health plans. The primary objective was to verify whether the new TPA’s system was set up appropriately according to each plan’s stated benefits.
Read MoreTo ensure only eligible dependents were enrolled for health benefits, this manufacturer engaged BMI to verify whether any of the 809 dependents were eligible according to plan eligibility requirements.
Read MoreFor over 10 years, this large public school district has engaged BMI to conduct annual pharmaceutical audits of their prescription drug plans and pharmacy benefit manager (“PBM”).
Read MoreA manufacturer with 270 employees engaged BMI to verify whether any of the 688 enrolled dependents met the plan’s eligibility and spousal surcharge criteria.
Read MoreAn 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.
Read MoreA 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 More
