This major metropolitan hospital engaged BMI to conduct a pharmaceutical audits of their prescription drug plan and pharmacy benefit manager (“PBM”) to ensure claims were being processed correctly.
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A food and beverage retailer with 709 employees engaged BMI to verify whether any of the 1,383 enrolled dependents met the plan’s eligibility and spousal surcharge criteria.
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A statewide association of financial institutions engaged BMI to conduct an audit of their member’s medical claims paid by their third-party administrator (“TPA”). The association reported higher than expected costs and claimant activity with suspicion of various claims processing issues.
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A large regional hospital with over 1,200 employees engaged BMI to verify if 2,643 enrolled dependents were eligible according to plan eligibility requirements. Their last dependent verification audit was conducted over 5 years ago.
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This communications sector client with 3,500 employees approached BMI to conduct a pre-implementation audit after a segment of the company was carved out and paired with a new third-party administrator (“TPA”) for their health plans. The primary objective was to verify whether the new TPA’s system was set up appropriately according to each plan’s stated benefits.
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To ensure only eligible dependents were enrolled for health benefits, this manufacturer engaged BMI to verify whether any of the 809 dependents were eligible according to plan eligibility requirements.
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For over 10 years, this large public school district has engaged BMI to conduct annual pharmaceutical audits of their prescription drug plans and pharmacy benefit manager (“PBM”).
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A manufacturer with 270 employees engaged BMI to verify whether any of the 688 enrolled dependents met the plan’s eligibility and spousal surcharge criteria.
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An engineering firm with over 7,000 employees engaged BMI to conduct of medical claims adjudicated by their third-party administrator (“TPA”) after suspecting some COVID-19 claim related expenses were incorrect.
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A manufacturer wanted to verify whether any of their 113 employees had enrolled a spouse who had other coverage available to them through employment. If so, the spouse would be ineligible for the manufacturer’s health plan through their “working spousal carve out” plan provision.
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As a result of this medical claims audit, the plan’s TPA agreed to initial overpayment amounts exceeding $56,000 and has initiated refund processes. Manual processor error was given as the cause for many of the identified issues.
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Looking to help combat rising health insurance costs, a construction company with 159 employees approached BMI to confirm that only eligible dependent children and spouses were enrolled in the company’s health plans.
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Since 2011, this city government engages BMI to conduct biennial audits to verify the accuracy of medical claims paid by their third-party administrator (“TPA”).
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A school district with 259 employees approached BMI to conduct a dependent eligibility audit after discovering that an employee’s ex-spouse was incurring costs on their health plans.
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The TPA agreed to initial overpayment amounts exceeding $5,000, however, further investigation of claims samples by the TPA revealed an additional $150,000 in errant claims outside of those sampled through the audit.
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A manufacturer with 358 employees approached BMI to conduct a dependent eligibility audit after suspecting ineligible dependents were enrolled on the plan causing costs to increase unnecessarily.
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A client within the healthcare sector approached BMI to conduct a pre-implementation audit after deciding to consolidate two different existing plans with a single third-party administrator (“TPA”) in order to verify whether the TPA’s system was set up appropriately according to each plan’s benefits.
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A previous audit by BMI led to the identification of over 100 ineligible dependents resulting in hundreds of thousands of dollars in savings.
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A large supermarket chain engaged BMI to verify whether issues uncovered in their last medical claims audit were ultimately fixed by their third-party administrator (“TPA”).
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A national retailer with 470 employees approached BMI to conduct a review of dependent coverage elected by plan participants and to validate whether enrolled dependents met the plan’s eligibility requirements.
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