Our engagement process is designed to minimize disruption to your operations while maximizing the depth and value of our analysis. From initial consultation through ongoing monitoring, we guide you through every step.
The BCI Process
Initial Consultation
We begin with a discovery call to understand your plan structure, current challenges, and goals. During this conversation, we'll explain our process, answer questions, and determine if BCI is the right fit for your needs. There's no obligation — this is simply an opportunity to explore how we can help.
Data Request & Transfer
Once engaged, we provide a detailed data request outlining exactly what we need from your TPA or claims administrator. Typically, we request 2-4 years of historical claims data. All data transfers occur through secure, HIPAA-compliant channels. We enter into a Business Associate Agreement (BAA) to ensure your data is protected.
Data Ingestion & Validation
Our team processes and validates your data, ensuring completeness and accuracy before analysis begins. We map your data to our analytical framework and flag any gaps or quality issues that need to be addressed. This step ensures the integrity of all subsequent analysis.
AI-Powered Analysis
Your claims data flows through our Integrity Analysis Platform — a proprietary system using advanced machine learning, pattern recognition, and rule-based logic. Unlike sample-based audits, we analyze 100% of transactions, applying over 30 unique analytical insights to identify fraud, waste, abuse, and errors.
Expert Review
Our experienced analysts review the AI-generated findings, validating results and adding context. We examine provider billing patterns, compare your plan performance against national benchmarks, and prioritize findings by recovery potential and compliance risk.
Integrity Report Delivery
Within approximately 90 days, you receive a comprehensive Integrity Report documenting all findings. Each issue includes detailed evidence, claim-level specifics, and recovery recommendations. The report is designed to be legally defensible and actionable — ready for your attorneys, fiduciaries, and recovery efforts.
Recovery Support
We don't just hand you a report and walk away. Our team provides guidance on recovery strategies, supports demand letter preparation, and offers expertise throughout the recovery process. We help you engage with TPAs, providers, and other parties to maximize actual dollar recovery.
Ongoing Monitoring (Optional)
After the initial audit, many clients choose ongoing monitoring to catch issues in real-time rather than retrospectively. This service provides continuous protection, prevents future overpayments, and maintains compliance — at a lower cost than periodic full audits.
Our Technology: The Integrity Analysis Platform
At the heart of our process is our proprietary Integrity Analysis Platform (IAP). This technology enables us to deliver analyses that were previously impossible to perform:
- Advanced Machine Learning: Pattern recognition algorithms trained on data covering 310+ million Americans
- Rule-Based Logic: Thousands of rules based on billing codes, contractual requirements, and regulatory standards
- Scalable Architecture: Capable of processing 15-20 million transactions per month
- Comparative Analytics: Benchmark your plan against industry standards and geographic norms
- HIPAA-Compliant Environment: All processing occurs in secure, compliant infrastructure
What We Analyze
Our platform examines every aspect of your claims data:
- Payment accuracy vs. contracted rates
- Duplicate payments and billing errors
- Invalid or outdated procedure codes
- Upcoding and unbundling patterns
- Out-of-network payment irregularities
- Coordination of benefits issues
- Provider billing anomalies
- Network discount application accuracy
- ER vs. urgent care facility coding
- Mental health parity compliance
- And many more analytical categories...
Timeline
A typical engagement follows this timeline:
- Week 1-2: Initial consultation and engagement agreement
- Week 2-4: Data request and transfer coordination with your TPA
- Week 4-6: Data ingestion and validation
- Week 6-12: Analysis and expert review
- Week 12-14: Integrity Report delivery and review meeting
- Ongoing: Recovery support and optional monitoring
Your Data Rights
Under the Consolidated Appropriations Act of 2021, plan sponsors have the right to access their claims data. "Gag clauses" that restrict this access are prohibited. If your TPA or administrator is reluctant to provide data, we can help you understand your rights and navigate the request process.