Close

Self-Insurance Programs

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 …

Read More

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
Read More

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
Read More

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 …

Read More

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 …

Read More

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
Read More

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%
Read More

State Requires Self-Insurance Programs to Conduct an Audit

Business Situation:
This municipality was located in a state that requires all local governments who self-insure medical coverage for their employees to obtain a claims audit every three years at a minimum.

Audit Finding:
Following an on-site visit to the third-party administrator’s claims payment facility, BMI identified 37 different categories

Read More