.svg)
While the market increasingly leans on shallow automation, we keep the human element payment integrity demands. Accuracy is delivered by our experts, with technology accelerating the work—not replacing judgment. Every decision is made by auditors, not algorithms.
About Us: Our Approach
Human-led. Tech-enabled. Auditor-controlled.
Payment integrity only works when people, technology and oversight move in the same direction.
Our Model
How our model works.
Human-Led Payment Integrity
Intelligence. Experience. Defensibility.
Penstock invests in expert reviewers who understand clinical context, payer policy, contract language, and real-world claim behavior. That expertise shows up in every finding.
Clinical Expertise
Clinical experts validate documentation and policy compliance against industry standards.
Our clinicians assess whether the documentation supports what was billed, follows plan policy, and aligns with industry standards for appropriate care. Their expertise strengthens defensibility and provides depth algorithms alone can’t deliver.
Coding & Audit Accuracy
Certified coders and auditors ensuring clean, defensible findings.
Our coding experts evaluate HCPCS/CPT accuracy, modifier use, documentation alignment and billing patterns across specialties. They identify where codes were misapplied, unsupported, or inconsistent with policy, producing clean, well-reasoned worklists that stand up to scrutiny.
Regulatory Insight
Experts fluent in state, federal, and payer-specific requirements.
Our team interprets coverage rules, contract language, state-by-state regulations, and emerging compliance trends, so every finding is grounded in the right policy.
Data Science & Methodology
Analysts who surface systemic patterns and root causes.
From overpayment concept development to recurrent trend validation, our data scientists identify upstream opportunities and help you translate findings into preventable errors.
Tech-Enabled Payment Integrity
Technology designed for protection and precision.
Penstock’s internal technology was shaped directly by our audit teams to enhance speed, clarity, and consistency—without ever replacing human judgment. Every component is secured with strict data-protection standards to keep member information safe.
Auditor-controlled Payment Integrity
Our commitments.
Our experienced auditors have control over every decision. Our technology speeds the work, surfaces patterns, and organizes data, but the judgment, defensibility and transparency come from people who understand the full context of each claim. This is the reason we can uphold the commitments that define how we work with every health plan.
Explainable, evidence-backed decisions
Every finding is explainable, traceable, and backed by clear artifacts—no black-box algorithms, no hidden logic.
Responsiveness you can count on
Dedicated client services leader, SLA-driven response times, weekly worklists, and clear status updates.
Defensibility in every determination
Because auditors—not automation—make the final call, our findings hold up through provider conversations, internal reviews, and appeals.
Collaboration at every step
Your team gets direct access to the experts doing the work. We explain decisions, prepare provider-ready documentation, and stand beside you in market.
Root-cause insight for real improvement
Auditors see the full picture—not just the anomaly—so we can identify systemic issues and guide future cost-avoidance.
Our Services
Expertise is why our audits are precise. Depth is why our clients trust us.
Penstock goes beyond surface-level reviews to understand the full context of each claim, and to give plans the attention, explanation and post-pay partnership they’ve been missing.
Data mining
Sophisticated overpayment concepts across all lines of business (Commercial, MA, Medicaid).
Learn more
Itemized Bill Review
Tech-enabled line-level analysis that uncovers billing errors across complex invoices.
Learn more
Upcoding Prevention Program
Analytics that flag unsupported E&M levels and reduce persistent upcoding patterns.
Learn more
The Proof Is in the Numbers
Performance that stands up to scrutiny.
Our results don’t just speak for themselves—they hold up under audit, appeal, and analysis. Every figure reflects real dollars recovered, real accuracy reinforced, and real trust earned.
Data mining:
4-6+
new data-mining concepts each month
≈ $225K
in incremental recovery per month, per 1M covered lives
Chart Review:
61%
of claims reviewed result in a finding
6.5%
98%
appeal rate / net-appeal uphold rate
Real dollars. Real defensibility. Real results.
Client success stories
.webp)