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Dependent Eligibility Audit Proves Beneficial in Battling Rising Health Care Costs

Business Situation:

After facing significant rising costs in the health plan, this warehousing client elected to conduct a dependent eligibility audit to ensure their 208 employees were not covering ineligible dependents.

 Solution:

BMI customized an audit plan to meet the following objectives:

  • Communicate the purpose of the audit, deadlines, compliance
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Pharmaceutical Contract Review Yields Significant Cost Recovery

Business Situation:

This client engaged BMI to conduct a pharmaceutical claims audit and contract review of their self-insured pharmaceutical plans and third-party administrator (TPA), with an emphasis on whether all financial and performance guarantees were met per their pharmaceutical ASO contract.

Solution:

In addition to a full-service pharmaceutical drug audit, …

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Savings Follow Audit of Enrolled Dependents after Open Enrollment

Business Situation:

This public entity wished to conduct a dependent eligibility audit of all enrolled dependents following open enrollment to ensure there was a “clean slate” going forward.

Client Profile:

  • County Government
  • 876 Employees Covering 1,973 Dependents

Audit Finding:

The client achieved a 97% employee response rate to the dependent …

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Claims Audit of Third-Party Administrator Confirms Suspicions

Business Situation:

This client engaged BMI to conduct a claims audit of their self-insured medical plan after suspecting manual and electronic processing errors, payment for excluded services and overall inconsistent adjudication practices by their third-party administrator.

Solution:

The client and BMI agreed upon the following objectives for an audit:

  • Analyze
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Small Investment for Dependent Eligibility Audit Produces Meaningful Results

Business Situation:

To help reduce health care expenditures, this client chose to conduct a dependent eligibility audit to verify whether or not enrolled dependents met eligibility requirements for the company’s two medical plans.

 Client Profile:

  • Aviation Operator
  • 303 Employees Covering 693 Dependents 

Audit Finding:

The client achieved a 100% employee …

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The Benefits of Testing a Third-Party Administrator’s Effectiveness

Business Situation:

After suspecting some claims were being paid in conflict with the plan’s intent, this client engaged BMI to conduct a claims audit of their self-insured medical plan.

Solution:

The client and BMI agreed upon the following objectives for an audit:

  • Analyze 100% of all claims paid during a
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Outsourcing a Dependent Eligibility Audit Proves to be Successful

Business Situation:

This client provides comprehensive benefits to employees and their families, but acknowledged that they failed to consistently verify eligibility of new dependents due to limited resources.   To help keep costs down and to free up resources, BMI was hired to conduct an audit of all enrolled dependents.

Client

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Claims and Dependent Eligibility Audit Combination Exceeds Expectations

Business Situation:

As part of a comprehensive risk management program, this client engaged BMI to conduct an audit of their third-party administrator to validate compliance and an audit of all enrolled dependents to verify eligibility.

Client Profile:

  • School District
  • 272 Employees Covering 693 Dependents

Claims Audit Finding:

  • Medicare claims paid
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Small Group Achieves Big Savings Investing in Dependent Eligibility Audit

Business Situation:
This client approached BMI to conduct a dependent eligibility audit after reading about the savings obtained from a similar sized organization in a previous Audit Finding of the Month.

 

Client Profile:

  • Manufacturing
  • 223 Employees Covering 456 Dependents
 

Audit Finding:
The client achieved a 98% employee response …

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Claims Audit Reduces Fiduciary Risk and Future Expenditures

Business Situation:
Faced with potential increased scrutiny of fiduciary responsibility by the Department of Labor, this client engaged BMI to conduct an audit of their self-insured medical plan to demonstrate due diligence.

 
Solution:
Utilizing our experienced staff and proprietary AUDiT iQ™ software, BMI set the following objectives:
  • Review 100%
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