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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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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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Pre-Implementation Audits – An ounce of prevention is worth a pound of cure.

Business Situation:
After making changes to benefit plan design from the prior plan year, this employer engaged BMI to conduct a pre-implementation audit to verify that the claim administrator’s system was programmed correctly.
 
Solution:
After reviewing plan documentation, auditors reviewed and set up over 85 test scenarios focusing on
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Dependent Eligibility Audits: Real Findings Equate to Real Savings

Business Situations:
A national retailer, small manufacturer, large city government, hospital, and Fortune 500 Company were all looking to reduce their overall health care costs in a variety of different ways, yet all of them reached the same conclusion: A dependent eligibility audit performed by an experienced outside organization was

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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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Investing in a Dependent Eligibility Audit Produces Big Returns

Business Situation:
This client provides a comprehensive medical benefits package to employees and their families, but wished to avoid payment of claims for ineligible dependents. To accomplish this, the client hired BMI to conduct a dependent eligibility audit. 
Client Profile:

  • Retailer
  • 331 Employees Covering 742 Dependents
 Audit Finding:
The …
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