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Implementation Audit FAQ’s

An implementation audit is a series of testing against an administrator’s system to ensure a complete and accurate setup when a new plan or changes to an existing plan go live. This type of audit can also be referred to as implementation review, plan setup testing, pre-implementation audit, post-implementation audit, etc.

Employers who are experiencing any of the following:

• Changing to a new third-party administrator

• Making changes to member benefits

• Moving to a self-insured model

BMI offers implementation audits for medical and prescription drug benefit plans.

Many administrators claim to perform an internal review of their set up, but these are often biased and favor standard processing approaches even when they do not align with plan design. With an objective perspective, an outside auditing firm can look at the set up with members and the employer in mind to catch mistakes before claims are processed.

Ideally, implementation audits should be conducted roughly 3-4 months before changes go live. In order to get the timing right, it’s recommended to connect with BMI 4-6 months prior to the go-live date.

Yes, if within 3-4 months of the plan going live. Although not ideal, it’s still early enough to test the system. The audit would simply be referred to as a post-implementation audit.

BMI utilizes pseudo-claims which have been created specifically for implementation audits. These claims allow the team to hand-pick testing scenarios based on plan documentation to ensure a broad spectrum of benefits are tested.

Cost is dependent on how many unique plans are to be audited. Many times, third-party administrators will help fund the cost of an implementation audit. Request a quote so that we can provide you with an accurate estimate.