Case Study

Meticulous Second-Pass Penstock Audit Returns $4.8M to Medicare Advantage Health Insurer

Company Profile
Medicare Advantage Health Insurer
Opportunity

Audit Recovery
Second-Pass Audit Recovery

Impact
3,809
Post-payment, second-pass reviews (ongoing since March 2022)
$4.8M
In potential savings

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.

Efficient Workflow

We leveraged our proprietary ClearBridge software to manage a seamless end-to-end audit workflow.

Robust Reporting

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

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

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!

Featured

Related News and Events

Explore the latest news and events from Penstock
Find out how a 'second pass' audit by Penstock leveraged expert knowledge to reveal $2.5MM
Discover how Penstock's comprehensive analysis and expertise in compliance led to the identification and recovery
ee how Penstock's in-depth analysis and regulatory expertise helped a New York non-profit health plan

Let’s get started

Ready to mitigate recurring, high-cost claim errors?

Service

From training and education to technology and scale, we’ll help your health plan transform into a payment integrity powerhouse.

SaaS

Audit Smarter with ClearBridge, an all-in-one audit workflow software built by auditors, for auditors. Streamline search, reporting, and edits without relying on IT.

We're always innovating.

Our team is continuously inventing and launching new solutions. Subscribe to our newsletter for the latest news & updates from Penstock.