Case Study Summary: Penstock found $4.8 million in potential savings for a Medicare Advantage health insurer by performing a meticulous second-pass post-payment audit—after seven incumbent vendors had already reviewed the same claims.

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A national Medicare health insurer was looking for a partner to conduct second-pass, post-payment audits of provider claims. Penstock was brought in after seven incumbent post-audit providers reviewed the data.

Solutions

Detailed Review

Rigorous examination of coding appropriateness and payment settings based on data and medical records documentation.

Anomaly Detection

Our sophisticated algorithmic methods and decades of skilled auditor expertise highlighted payment discrepancies, spotted anomalies and discerned patterns.

Robust Reporting

Provided in-depth, actionable reporting to help client understand their audit.

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We’ve identified an additional $5.0 million in overpayments to date, achieving an overall

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Client Success

Despite seven incumbent post audit providers previously reviewing the same data, we identified $4.8M in potential savings. This led to an awarded Payment Integrity contract, covering 10 additional states.

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