BMI Audit Services

BMI's medical and pharmacy claims audit services are designed to uncover what dollars are being spent on for self-insured benefits plans. Our processes provide a detailed review of claims data to confirm that plan language is being followed and dollars are not being wasted.

Plan sponsors are legally obligated to act in the best interest of plan participants and to ensure the plan is operating per the regulations of the Employee Retirement Income Security Act of 1975 (ERISA) and the Department of Labor (DOL). Audits assist in fulfilling due diligence and fiduciary responsibility while uncovering opportunities for plan optimization and future savings.

Our claims audit solutions include:

Medical Claims Audit: Analyze the claims data against the plan language to ensure compliance and reduce wasteful spending.
Pharmacy Claims Audit: Deep dive into payments and administration to verify the plan is operating in accordance with the plan language.
Financial Guarantee Audit: Evaluation of any financial or performance guarantees to ensure compliance as outlined in the Administrative Services Only agreement.
Pharmacy Rebate Audit: Review and analysis of selected manufacturer contracts and associated claims data, to ensure that all rebates have been identified and paid.