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CASE STUDY

CASE STUDY: Editing Sample Analysis

The image below displays the results of a Claims Editing analysis on a 50,000 life TPA. The results are based off billed charges, prior to any other editing applications or network discounts.

CASE STUDY: 56-year-old male with rotator cuff tear

A 56-year-old male was treated for an unspecified rotator cuff tear/ shoulder rupture that was specified as “traumatic.” The claim had been previously reviewed by a different vendor using an automated process that identified $10,000 in suspected errors. HPC’s nurses and professional coders reviewed the claim and discovered that $4,000 of the previously identified errors…

CASE STUDY: $260k Savings on Double Lung Transplant

An eight-year-old child received a double lung transplant. The total claim was billed at $1,200,000 with an existing network discount of 25%. HPC reviewed the claim for compliance and clinical issues and identified $260,000 in deniable charges. Using HPC’s services, the final cost of the claim was reduced to $708,000.

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