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Rob Temples

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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