A: BMI has audited almost every large and small claims payer and third-party administrator.
A: BMI customizes its proprietary audit software with all the exclusions, limitations and parameters of each employer’s plan, along with member eligibility records. Typically, we look at 100% of claims to verify the administrator of self-insured health plans paid the claims in keeping with the plan design. This process verifies claims were not overpaid and helps eliminate sources of excess costs that can contribute to the growth of health plan expenses.
A: BMI inherently operates in a regulatory environment requiring us to have a number of policies, practices and insurance coverages in place to help safeguard the sensitive data we work with on a day-to-day basis. Before any sensitive data is communicated, we require contracting parties to execute a HIPAA Business Associate Agreement. BMI’s privacy and security policy can be found here.
A: BMI identifies anywhere in between 2-10% of enrolled dependents are ineligible.
A: BMI’s standard Call Center operating hours are Monday through Thursday 8:00 am – 8:00 pm Eastern and Fridays 8:00 am – 5:00 pm Eastern.
A: BMI is considered a "Business Associate" under HIPAA regulations since we perform functions and activities on behalf of "Covered Entities" who are Plan Administrators and Plan Sponsors of employer group Health Plans. As a business associate, BMI receives protected health information when providing services, but maintains a contractual obligation with employers to protect this information and adhere to HIPAA privacy and security regulations. BMI will never request an ORIGINAL or CERTIFIED COPY of a birth or marriage certificate. A photocopy or fax of a document is not a legal document and it cannot be used to obtain any other personal form of identification. BMI does not outsource the handling of an audit. The BMI audit staff is all housed in one office location in a secure and locked environment which requires a key or passcode to enter the rooms where documents are receive and stored. Computer access to audit files can only be accessed with an individual auditor password. The audit process, staff training, and office structure are all designed to protect personal information.
A: The usual documents are: Spouse: a copy of a marriage license or a marriage certificate to verify your legal spouse. Dependent child: a copy of a birth certificate that identifies one or both parents. Some hospital birth records do provide sufficient information to be acceptable. The employee must be identified with the child, if that is not the case, then other additional supporting document may be required. If student status is a requirement of eligibility, a document from a school source will be required.