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health care benefits auditing

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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Audit of Dependent and Spousal Surcharge Eligibility Achieve Combined Savings

Business Situation & Client Profile:  

A regional hospital and healthcare center with 650 employees covering 1,480 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. Verification was previously performed internally.

 

Solution:

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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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Removal of Ineligible Dependents Translates to Savings

Business Situation & Client Profile:       

A city government provides a comprehensive benefits package to 1,304 employees and their 2,663 dependents. To avoid payment of health claim claims for ineligible dependents, the city contracted with BMI to administer a comprehensive dependent eligibility audit.

 Solution:

BMI customized an audit plan to meet …

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Pharmaceutical Audits Yield Significant Cost Recovery

Business Situation 

This public school district engaged BMI to conduct a pharmaceutical claims audit of their self-insured pharmaceutical plans and pharmacy benefit manager (PBM).  In addition, the client also engaged BMI to conduct an on-site rebate audit, as well as a complete contractual financial guarantee audit.

Solution

BMI performed three …

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Savings Continue Following Annual Dependent Eligibility Audit

Business Situation & Client Profile:       

This manufacturing client contacted BMI to conduct an annual dependent eligibility audit of all 2,361 enrolled dependents due to high turnover and limited resources to verify eligibility for new hires. Their last audit with BMI resulted in over $450,000 in annual savings.

 Solution:

BMI customized …

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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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Dependent Verification Prevents Future Unnecessary Health Plan Expenses

Business Situation:

A food distribution company approached BMI to verify the eligibility of all 2,867 dependents enrolled in the company’s health plans after continuing to see rising health care costs.

 Solution:

BMI customized an audit plan to meet the following objectives:

  • Communicate the purpose of the audit, deadlines, compliance requirements,
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Claims and Dependent Eligibility Audit Combination Achieves Savings

Business Situation:

As part of an effort to reduce overall health care costs, 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:

  • Non-Profit Organization
  • 718 Employees Covering 1,414 Dependents

 Claims Audit Finding:

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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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