Close

systemic flaw

BMI Audit Finding of the Month: Multiple Claims Paid in Error Due to Systemic Flaw

Audit Issue:
The audited health plan specifically excluded services relating to pregnancy of a dependent child except for complications of pregnancy.
Audit Finding:
Multiple claims were identified as being paid for excluded routine pregnancy services.
TPA Response:
The claims administrator agreed that claims were paid in error. In investigating the
Read More