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BMI Audit Services

Combined Savings: Audit of Dependent Eligibility & Spousal Surcharge

Business Situation & Client Profile:  

A small employer group with 259 employees covering 600 dependents contacted BMI to: 1) verify the eligibility of all dependents and 2) determine whether or not enrolled spouses should be paying a spousal surcharge per the plan.

Solution:

BMI customized an audit plan to meet …

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Medical & Rx Audit Yields Big Savings for Employer Group

Business Situation 

At the recommendation of their consultant following concerns about the accuracy of claims adjudication, this employer group approached BMI to conduct an audit of medical and prescription drug claims paid by their third-party administrator.

 

Solution

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

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Small Group Achieves Big Savings with Dependent Eligibility Verification

Business Situation & Client Profile:  

Following successful claims audits conducted with this organization’s affiliate, this small manufacturer approached BMI to help confirm if enrolled dependents actually met the organization’s self-funded medical plan eligibility requirements.

 

Solution:

BMI customized a dependent eligibility verification plan to meet the following goals:

  • Communicate the
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Comprehensive Audit of Medical Claims Uncovers Errors

Business Situation 

In support of due diligence efforts, a construction industry health and welfare fund approached BMI to conduct a comprehensive audit of 24 months of medical claims paid by their third-party administrator.

 

Solution

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

  • Analyze
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Dependent Verification Saves Group Over 2 Million

Business Situation & Client Profile:  

This city and county government approached BMI to help confirm if health care plan dollars were being spent appropriately by verifying the eligibility of 7,596 enrolled dependents.

 

Solution:

BMI customized a dependent eligibility verification plan to meet the following goals:

  • Communicate the purpose of
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Claims Audits Test Third-Party Administrator Effectiveness

Business Situation 

Every few years this large group of public school districts relies on BMI to conduct a thorough review of medical claims paid by their third-party administrator to ensure the plan’s assets are being used appropriately for the sole benefit of plan participants.

 

Solution

Utilizing our experienced staff …

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Savings Follow Audit of Client’s Third-Party Administrator

Business Situation 

BMI was engaged to audit this manufacturer’s new third-party administrator for both their medical and prescription drug plans to ensure benefits were being paid appropriately and to evaluate overall administrative effectiveness.

 

Solution

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

  • Analyze
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Savings Follow Verification of Spousal Eligibility

Business Situation & Client Profile:  

To ease the burden of rising health care costs, this manufacturer enlisted BMI’s assistance to verify if 344 enrolled spouses were eligible under their employer’s health plan and therefore ineligible on the manufacturer’s plan. The employer also elected to verify the eligibility of 623 dependent …

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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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Small Employer Achieves Big Savings through Dependent Eligibility Audit

Business Situation & Client Profile:  

Facing rising costs to provide employee benefits, this institute of higher education contacted BMI to verify the eligibility of all 484 dependents enrolled in their health care plans.

 Solution:

BMI customized a dependent eligibility audit plan to meet the following goals:

  • Communicate the purpose of
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