Since 2011, our Audit Finding of the Month provides insights into what drives BMI to help organizations uncover who and what their healthcare dollars are being spent on.
Discover how a multi-employer health plan used a dependent eligibility audit by BMI Audit Services to save $2.42 million in just one year. Learn the process, results, and benefits of auditing dependent health coverage.
An employer in the healthcare field with 4,000 employees engaged BMI to conduct an implementation audit of their new third-party administrator (“TPA”) to ensure accuracy of their claims processing prior to going live for the new plan year.
A major retail employer suspected their medical claims weren’t being processed correctly—and they were right. With the help of BMI Audit Services, they uncovered $28K+ in overpayments due to errors in copayments, coordination of benefits, and plan exclusions.
The Consolidated Appropriations Act of 2021 (CAA) significantly impacts group health plan fiduciaries by eliminating restrictions on data transparency and requiring fiduciaries to monitor their service providers. The Department of Labor (DOL) mandates that plan sponsors ensure plan resources are used correctly, with failure to uphold fiduciary duties leading to severe penalties. This white paper explores the implications of gag clause prohibitions, the importance of claims audits, and how plan sponsors can comply with these regulations to safeguard their fiduciary responsibilities.
A food and beverage industry employer, in collaboration with their employee benefits broker, partnered with BMI Audit to conduct a comprehensive medical claims audit after identifying significant errors in claims processing by their third-party administrator (TPA).
Discover how BMI's tailored dependent eligibility verification process helped clients save $791,000 by removing ineligible dependents. Learn about the audit findings, streamlined solutions, and measurable ROI for ongoing plan management.
A Native American Organization with over 9,000 enrolled members engaged BMI to audit and verify the accuracy of medical and prescription drug claims paid their third-party administrator (“TPA”) and pharmacy benefits manager (“PBM”).
A labor union engaged BMI to verify the eligibility of 1,047 health plan dependents, ensuring compliance and reducing costs. BMI provided bilingual support, managed documentation securely, and identified 51 ineligible dependents, removing them from coverage. The audit led to $357,000 in annual savings and achieved a 2,356% ROI by eliminating ineligible enrollees.
