A major retail employer suspected their medical claims weren’t being processed correctly—and they were right. With the help of BMI Audit Services, they uncovered $28K+ in overpayments due to errors in copayments, coordination of benefits, and plan exclusions.
Read MoreThe Consolidated Appropriations Act of 2021 (CAA) significantly impacts group health plan fiduciaries by eliminating restrictions on data transparency and requiring fiduciaries to monitor their service providers. The Department of Labor (DOL) mandates that plan sponsors ensure plan resources are used correctly, with failure to uphold fiduciary duties leading to severe penalties. This white paper explores the implications of gag clause prohibitions, the importance of claims audits, and how plan sponsors can comply with these regulations to safeguard their fiduciary responsibilities.
Read MoreA food and beverage industry employer, in collaboration with their employee benefits broker, partnered with BMI Audit to conduct a comprehensive medical claims audit after identifying significant errors in claims processing by their third-party administrator (TPA).
Read MoreDiscover how BMI's tailored dependent eligibility verification process helped clients save $791,000 by removing ineligible dependents. Learn about the audit findings, streamlined solutions, and measurable ROI for ongoing plan management.
Read MoreA Native American Organization with over 9,000 enrolled members engaged BMI to audit and verify the accuracy of medical and prescription drug claims paid their third-party administrator (“TPA”) and pharmacy benefits manager (“PBM”).
Read MoreA labor union engaged BMI to verify the eligibility of 1,047 health plan dependents, ensuring compliance and reducing costs. BMI provided bilingual support, managed documentation securely, and identified 51 ineligible dependents, removing them from coverage. The audit led to $357,000 in annual savings and achieved a 2,356% ROI by eliminating ineligible enrollees.
Read MoreAn employer in the manufacturing industry with over 450 employees engaged BMI to audit and verify the accuracy of medical and prescription claims payments. Both the medical and pharmacy claims audits identified errors related to claims processing, including payment for ineligible services and systemic administrative issues. The TPA agreed to overpayment amounts totaling over $70,000 and to run additional impact reports to identify any other claims impacted by the systemic issues uncovered. Follow-up audits are recommended for both areas to monitor progress and minimize financial risk.
Read MoreA consortium of regional school districts working together to save taxpayer dollars engaged BMI to verify the eligibility of 3,735 total spouses and children on their health plans. Plan eligibility rules contained a “working spouse” provision which meant any of the 1,207 spouses who had other coverage available to them through employment were ineligible.
Read MoreAn employer in the automotive industry with over 10,000 employees engaged BMI to audit and verify the accuracy of medical claims paid by their third-party administrator (“TPA”). The employer had not previously conducted an audit despite being with the TPA for several years.
Read MoreThe school district realized that they do not request proof from employees to confirm dependent eligibility during enrollment, which poses a potential risk. As a result, BMI was engaged to verify the eligibility of 1,599 dependents on their medical plans before the next open enrollment.
Read MoreAn organization in the banking and financial industry asked BMI to verify the eligibility for 1,181 enrolled dependents on their medical plans. Previous checks by BMI in 2016 and 2019 resulted in the removal of 71 ineligible dependents, saving over $250,000.
Read MoreA city government was exploring several options to keep healthcare benefit costs from increasingly unnecessarily and engaged BMI to verify the eligibility of 1,495 dependents enrolled in the group’s health plans.
Read MoreA statewide professional organization in the banking industry contacted BMI after catching several medical claims processing errors by their third-party administrator (“TPA”). Since these mistakes were stumbled upon by accident, a request for a full claims audit was made to ensure all claims were being paid appropriately under the plan.
Read MoreA small manufacturer and exporter of recycled materials contacted BMI to verify the eligibility of 84 enrolled dependents on the group’s health plans.
Read MoreA statewide association of legal professionals contacted BMI to perform an audit of medical claims paid by their third-party administrator (“TPA”) and verify accuracy of claims paid on their behalf.
Read MoreThis transportation and logistics company periodically engages with BMI for dependent eligibility verification. Their previous audit was completed in 2017 and resulted in 180 dependents removed which equated to $630,000 in annual savings.
This most recent audit included the verification of 1,390 enrolled dependents to ensure there were no changes in eligibility and that all newly enrolled dependents were eligible for benefits.
Read MoreA large insurance pool of educators consisting of over 10,000 employees contacted BMI to perform an audit of claims paid by their third-party administrator (“TPA”). The primary reason for the audit was because the TPA moved to a new platform for claims processing and no prior audits were ever conducted.
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