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Dependent Verification Equates to Real Savings

Business Situation & Client Profile:  

To ease the burden of rising health care costs and reduce risk, this manufacturer enlisted BMI’s assistance with dependent verification of  1,020 enrolled dependents on the health plan.

 

Solution:

BMI customized a dependent eligibility audit plan to meet the following goals:

  • Communicate the purpose
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Pharmaceutical Audits Yield Significant Cost Recovery

Business Situation 

This public school district engaged BMI to conduct a pharmaceutical claims audit of their self-insured pharmaceutical plans and pharmacy benefit manager (PBM).  In addition, the client also engaged BMI to conduct an on-site rebate audit, as well as a complete contractual financial guarantee audit.

Solution

BMI performed three …

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Due Diligence Claims Audit Uncovers Unintended Plan Expenses

Business Situation:

This client engaged BMI to conduct a claims audit of their self-insured medical plan for due diligence purposes.

Solution:

Utilizing our experienced staff and proprietary AUDiT iQ™ software, BMI set the following objectives:

  • Review 100% of all claims paid during an 18 month period.
  • Test claims against Summary
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Claims and Dependent Eligibility Audit Combination Achieves Savings

Business Situation:

As part of an effort to reduce overall health care costs, 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:

  • Non-Profit Organization
  • 718 Employees Covering 1,414 Dependents

 Claims Audit Finding:

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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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Dependent Eligibility Audit Results in Over 3 Million in Annual Savings.

Business Situation:
This client approached BMI to conduct a dependent eligibility audit due to limited internal resources and to gain better understanding their plan’s eligibility requirements.

 

Client Profile:

  • Health Care
  • 4,579 Employees Covering 9,902 Dependents
 

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

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Claims Audits – Immediate and Long-term Cost Reduction Strategy

Business Situation:
Our client’s employee benefits consultant engaged us to conduct an audit of their client’s third-party administrator to ensure medical and prescription drug claims were being paid appropriately.

 
Solution:

Utilizing our experienced staff and proprietary AUDiT iQ™ software, BMI set the following objectives:

  • Review 100% of all claims
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Pre-Implementation Audits – An ounce of prevention is worth a pound of cure.

Business Situation:  
After dropping some plan options and adjusting others from the prior plan year, this employer engaged BMI to conduct a pre-implementation audit with their claims administrator.   
 
 Audit Finding: 
BMI tested areas with claims scenarios that included, but were not limited to
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