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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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Dependent Verification Equates to Real Savings

Business Situation & Client Profile:  

To ease the burden of rising health care costs and reduce risk, this manufacturer enlisted BMI’s assistance with dependent verification of  1,020 enrolled dependents on the health plan.

 

Solution:

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

  • Communicate the purpose
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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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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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Ineligible Dependents Found Across Multiple Coverages

Business Situation:
Because covering ineligible dependents drives up the costs of health care for all participants, this client came to us to identify any enrollees in medical, dental and vision who did not meet eligibility criteria while also complying with ERISA requirements.

Client Profile:
  • Manufacturer within the technology and communications
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Client Achieves a 1,200% Return of Investment Ratio

This time of year is ideal for any employers considering a dependent eligibility audit.  Any intentions to audit can be communicated to employees during open enrollment with an audit shortly following after enrollment closes.

Business Situation:
A large diversified worldwide specialty metals producer came to BMI regarding their needs for

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Auditing: Control Spending While Decreasing Health Care Costs

Smart Business recently spoke with key executives at both Neace Lukens and GBQ Physician Practice Group about how conducting a dependent eligibility audit can help control wasteful spending and ensure compliance with requirements such as ERISA and Sarbanes-Oxley. Both articles are a great resource to those new to and familiar
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