This client’s employee benefits broker approached BMI for reassurance of proper plan adjudication after their third-party administrator reimbursed the group for errant claim payments.
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A small employer group with 259 employees covering 600 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.
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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.
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Following successful claims audits conducted with this organization’s affiliate, this small manufacturer approached BMI to help confirm if enrolled dependents actually met the organization’s self-funded medical plan eligibility requirements.
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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.
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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.
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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.
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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.
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BMI was engaged to audit this manufacturer’s new third-party administrator for both their medical and prescription drug plans to ensure benefits were being paid appropriately and to evaluate overall administrative effectiveness.
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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 children enrolled on the plan.
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This city government approached BMI to conduct a retrospective audit of medical claims following concerns about proper adjudication.
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