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AUDiT iQ

Medical Claims Audit Yields Significant Cost Recovery

Business Situation 

This city government approached BMI to conduct a retrospective audit of medical claims following concerns about proper adjudication.

Solution

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

  • Analyze 100% of all medical claims paid by the third-party administrator during a 24 month
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Claims Audits – An Immediate and Future Cost Reduction Strategy

Business Situation 

This county government client approached BMI to conduct an audit of medical and prescription drug claims for cost reduction purposes after a significant rise in insurance expenditures.

 

Solution

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

  • Analyze 100% of all medical
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Trust, but Verify – Annual Claims Audit Finds Mistakes Continued

Business Situation 

This religious institution began conducting annual external medical claims audits with BMI after their initial audit with BMI discovered claims being paid in conflict with the plan’s intent.

Solution

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

  • Analyze 100% of all claims
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Medical Claims Audit Starts Path to Savings & Corrective Actions

Business Situation:

As one of several cost containment initiatives, this client engaged BMI to conduct an audit of their self-insured medical plan in order to verify the accuracy of claims payments made on their behalf.

Solution:

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

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Medical Claims Audit Uncovers Additional Mistakes by TPA

Business Situation:

A labor union elected to conduct a medical claims audit following an unexpected increase in claims dollars compared to the previous year and the discovery of several adjudication mistakes.

Solution:

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

  • Analyze 100% of all
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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 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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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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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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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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