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Randy Light Managing Partner

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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Prescription Drug Claims Audit Uncovers 5 Years of Incorrect Adjudication

Business Situation:
BMI was engaged to audit this client’s contracted Pharmacy Benefit Manager (“PBM”) to determine whether claims were accurately adjudicated in accordance to benefit plan design, contractual pricing, and eligibility.


Solution:
Utilizing our experienced staff and proprietary AUDiT iQ™ software, BMI customized an audit plan to meet the following
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Dependent Eligibility Audit Verifies Eligibility of Dependents and Retirees

Business Situation:
This client was looking for a dependent eligibility audit firm who could verify the eligibility of enrolled dependents for both active employees and retirees.  Additionally, they wanted to verify benefit eligibility for each retiree.

 
Client Profile:
  • City Government
  • 5,367 Employees and Retirees Covering 11,523 Dependents
Audit
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Value Realized – Periodic Claims Audits Test TPA Effectiveness

Business Situation:
BMI was engaged to audit this client’s medical and prescription drug plans to ensure benefits were being paid appropriately by their third-party administrator and to test their overall administrative effectiveness.

The administrator agreed to pay for the outside audit after the client expressed concern over how certain benefits

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