TPA Auditing Services by BRMS

TPA Auditing Services

We can audit claim activity for accuracy and reimburse recovered funds

When you choose BRMS as your TPA, we can collect and review your previous TPA's data, audit claim activity for accuracy, and reimburse recovered funds.

Claim procedure auditing on prior administrators determines compliance, assesses timeliness of claims payment, determines monetary penalties, evaluates accuracy of payments, and captures for potential fraudulent and abusive claim submissions, duplicates and other errors.

An examination of the prior administrator's claim processing procedures includes, but is not limited to:

Duplicate Payments
Multiple Surgery Reimbursement
Incidental/Global Services
Unbundling/Up-Coding
Coordination of Benefit Payments
Medical Necessity
Anesthesia Paid Incorrectly
Participating Allowance, Hospital Discounts taken incorrectly

Technical and Professional Services processed incorrectly
Non-Covered, Comfort or Excluded Items
Services that have Dollar and/or Policy Limitation
Worker's Compensation/Automobile Accident
Fraud and Abuse
And more.

With risk management services that uncover, analyze and control potential losses due to unpredictable events, BRMS has a reputation for assisting companies in loss prevention and recovery.

Benefit and Risk Management Services