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Penstock uncovered $7.6 million in lab claim overpayments by analyzing high-volume, low-dollar claims that fell below standard payment integrity review thresholds. Applying CMS national coverage rules to nearly 500,000 claims across Medicaid and Marketplace plans in more than 30 states revealed significant overpayments missed by traditional workflows, demonstrating how deep, policy-driven data mining exposes risk that threshold-based reviews overlook.
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Deeper review. Clearer outcomes. Proven impact.
Every case study follows the same arc: attention uncovers what automation and surface-level review miss. See how deeper investigation reveals systemic issues, strengthens provider conversations, and returns meaningful dollars to plans.
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When Low-Dollar Errors Add Up: Uncovering $7.6M Below Standard Review Thresholds
Where real claims reveal real answers.
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Penstock’s thought leaders surface the patterns, processes, and system behaviors that shape payment accuracy. Explore perspectives grounded in real claim work—practical guidance, emerging trends, and expert analysis designed to help plans recover more, prevent more, and advance payment integrity.
Case Studies
Deeper review. Clearer outcomes. Proven impact.
Every case study follows the same arc: attention uncovers what automation and surface-level review miss. See how deeper investigation reveals systemic issues, strengthens provider conversations, and returns meaningful dollars to plans.
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Every case study follows the same arc: attention uncovers what automation and surface-level review miss. See how deeper investigation reveals systemic issues, strengthens provider conversations, and returns meaningful dollars to plans.