BMI is now Lumelight. From dependent eligibility verification to healthcare claims audits and implementation audits, our proven approach to protecting plan integrity now strengthens Lumelight’s broader commitment to simplify benefits oversight and safeguard every dollar.
Although administrators do their own testing prior to plan implementation, setup errors can fall through the cracks.
An implementation review is critical to ensure the integrity of your benefits plan.
If you are changing plan administrators, making changes to benefits or moving to a self-insured plan for the first time, it’s crucial to verify that the claims system is programmed correctly.
Our independent implementation audit verifies that the administrator understands the nuances of the plan language, has programmed the system according to plan intent, and is set up to pay claims correctly.
Confirm accurate setup of the claims administrator’s payment and records system before any claims are paid
Ensure systems and processes are in place that will optimize claims payment performance
Identify potential human misinterpretation or uncertainties of plan language
Enhance the claims administrator’s understanding of the plan
Fulfill due diligence and fiduciary responsibility
Deductibles, Coinsurance and Copays
Exclusions
Limitations
Out of Pocket
Benefit Period
Professional Services
Preventative Health Benefits
Inpatient/Outpatient Services
