Since 2011, our Audit Finding of the Month provides insights into what drives BMI to help organizations uncover who and what their healthcare dollars are being spent on.
Post-implementation audits act as a critical ‘second check’ for new health plan designs. In this case study, BMI reviewed 1,100+ medical and prescription claims scenarios, confirming accuracy, uncovering discrepancies, and helping the plan sponsor protect compliance and member trust.
An employer in the healthcare field with 4,000 employees engaged BMI to conduct an implementation audit of their new third-party administrator (“TPA”) to ensure accuracy of their claims processing prior to going live for the new plan year.
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.
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.
A client within the financial services industry approached BMI to conduct a pre-implementation audit after moving to a new carrier. Their primary objective was to verify whether the carrier’s system was set up appropriately to administrate their claims according to plan benefits.
