Health care benefits auditing is all we do. Accordingly, we offer a variety of resources to assist employers or their employee benefit consultants and brokers. Many resources are conveniently available to view and download, but we encourage you to contact us directly to explore how we can meet your exact needs.

BMI’s Audit Findings of the Month (“AFOM”) is distributed monthly to thousands of our customers, benefit consultants and brokers nationwide. Widely praised and featuring both claims and dependent eligibility audits, the AFOM has grown more popular than we ever imagined since its inception in 2011. Contact BMI today to receive the latest AFOM delivered to your email inbox or view it here.

Value Realized - Periodic Claims Audits Test Administrative Effectiveness
A Value Forward Approach To Auditing Proves Successful
Dependent Eligibility Audit Verifies Eligibility Of Dependents And Retirees
Small Group Achieves Big Savings From Dependent Eligibility Audit
Combined Audits Achieve Over 2,000% ROI

The cost of health care benefits is among the largest expense items for most employers. Plan sponsors put a lot of effort into designing health care benefits for their employees and need to be assured that these benefits are being provided at the right cost. Typically, this assurance comes from an independent audit of their third-party claims administrator.

Below are some of the most common problems solved through a claims audit performed by BMI.

Electronic claims payment systems minimize errors, but the complete claims payment process relies on human judgment. Weak investigative efforts, volume pressures, poor claims payment systems, outdated software, internal policies and human interpretation are just some of the factors that can attribute to claims payment issues.

Independent third-party testing of claims adjudication procedures can provide piece of mind and/or prevent costly future mistakes. Claims audits uncover a wide variety of claims adjudication issues and/or weaknesses such as system limitations, plan-build inaccuracies, overuse of processor overrides, and provider billing errors.

Trust, but verify. Third-party administrators often pay for a claims audit to restore customer confidence. A comprehensive analysis of claims can help determine whether or not an issue could be systemic or isolated.

Sponsors of health plans have a fiduciary obligation to participants and/or shareholders to confirm plan resources are being used correctly. Failure to uphold fiduciary duties can result in legal penalties for the Plan Administrator including personal financial liability.

With increasing forms of self-service online enrollment, lax eligibility vendor controls, and some plans even excluding spouses from dependent eligibility for coverage, the number of ineligible dependents for any given organization can range between 2-10%.

Below are some of the most common problems solved through a dependent eligibility audit performed by BMI.

Few forms of health care cost containment activities provide such immediate savings. Given the fact that the average dependent can cost an employer a minimum of $3,000 annually, it’s not uncommon for an employer to achieve returns on investment ranging from 100% to over 5,000%.

Employers can reduce their stop-loss denial risk by ensuring only eligible dependents are enrolled.

A thorough review of each dependent’s eligibility and supporting documentation can provide piece of mind or uncover dependents who should have never been enrolled. A dependent eligibility audit can also help the entire organization understand more about their own eligibility requirements.

Sponsors of health plans have a fiduciary obligation to participants and/or shareholders to confirm plan resources are being used correctly. Failure to uphold fiduciary duties can result in legal penalties for the Plan Administrator including personal financial liability.

Many organizations don’t realize that conducting a dependent eligibility audit internally is a significant undertaking. Hiring an outside vendor provides a buffer between human resources personnel and employees to ensure objectivity while also minimizing conflict.

Examine the benefits of conducting a claims audit or dependent eligibility audit
Each year BMI works with hundreds of small and large employee benefit consultant and brokerage firms on behalf of their clients
Medical Claims Audits
Prescription Drug Claims Audits
Dependent Eligibility Audits

Our national client base, consisting of Fortune 500 firms to employers with less than 200 employees rely on us each year to provide them with superior health care claims and dependent eligibility audit services and products. Below is a current list of the many client industries we serve:

  • Agriculture
  • Associations/Welfare Funds
  • Automotive
  • Aviation
  • Banking/Finance
  • Construction
  • Distribution
  • Education
  • Energy
  • Engineering
  • Entertainment
  • Food and Beverage
  • Government
  • Healthcare
  • Hospitality
  • Insurance/Risk Management
  • Labor Unions
  • Legal
  • Manufacturing
  • Mining
  • Native American Organizations
  • Non-profit
  • Publishing
  • Real Estate
  • Religious
  • Retail
  • Service
  • Technology/Communications
  • Transportation/Logistics