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Randy Light Managing Partner

Dependent Eligibility Audit Produces Substantial Savings

Business Situation:
This client chose to conduct a dependent eligibility audit to verify whether enrolled dependents met eligibility requirements. To increase comfort levels among enrollees, the client requested a BMI representative visit on-site to address questions and collect documentation.

Client Profile:
  • Resort and Casino
  • 1,085 Employees Covering 2,285 Dependents 
 
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Dependent Eligibility Audit Provides “Clean Slate” Prior to Open Enrollment

Business Situation:

This group health plan sponsor wished to conduct a dependent eligibility audit of all enrolled dependents prior to open enrollment to ensure there was a “clean slate” going forward.
Client Profile:
  • County Government
  • 1,035 Employees Covering 2,277 Dependents
Audit Finding:
The client achieved a 99% response rate to
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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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Claims Audits – Immediate and Future Cost Reduction Strategy

Business Situation:

For close to 10 years BMI has been engaged to audit this client’s medical plans every two years to ensure benefits are being paid appropriately by their third-party administrator and to test their overall administrative effectiveness.
Audit Finding:
Of the 62 categories of analytic testing performed in AUDiT
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Small Group Achieves Big Savings from Dependent Eligibility Audit

Business Situation:
This client came to us to identify any enrollees who did not meet eligibility criteria so that they could remove them to comply with ERISA requirements. 

Client Profile:
  • Real Estate
  • 548 Employees Covering 1,137 Dependents
 
Audit Finding:
  • 22 dependents (1.93% of total) were determined to be ineligible,
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State Requires Self-Insurance Programs to Conduct an Audit

Business Situation:
This municipality was located in a state that requires all local governments who self-insure medical coverage for their employees to obtain a claims audit every three years at a minimum.

Audit Finding:
Following an on-site visit to the third-party administrator’s claims payment facility, BMI identified 37 different categories

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Removing Ineligible Dependents Leads to Substantial Savings

Business Situation:
While providing comprehensive medical benefits packages to employees, this client wished to avoid payment of healthcare claims for ineligible dependents under the plan.

Client Profile:
  • Construction
  • 1,369 employees covering 2,878 dependents

Audit Finding
The audit consisted of three main separate mailing phases followed by an appeals period producing

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Value Realized – Periodic Claims Audits Test Administrative Effectiveness

Business Situation:
BMI is engaged to audit this client’s medical plans every two years to ensure benefits are being paid appropriately by their third-party administrator and to test their overall administrative effectiveness.

Audit Finding:

Using a combination of our proprietary software AUDiT iQ™ to analyze 100% of the claims and

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Re-Enrollment Audit Produces Significant Savings

Business Situation:
Trustees of this group decided to conduct a re-enrollment of all dependents receiving benefits to ensure that only currently eligible dependents receive benefits going forward.

Client Profile:
  • Multi-employer Trust
  • 2,554 employees covering 5,103 dependents

Audit Finding:

The audit consisted of three main separate mailing phases and produced the

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Audit of Plan Intent Leads to Corrective Actions

Business Situation:
To ensure plan compliance after making several plan changes, this client chose to conduct a claims audit of their administrator for their self-insured medical plan.

Audit Finding:

Using a combination of our proprietary software AUDiT iQ™ and the expertise of our audit staff to analyze 100% of the

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