Penstock conducted a detailed analysis of a regional Health Plan’s medical claims to evaluate compliance with the applicable requirements of NYS HCRA. Our evaluation focused on regulatory and NUBC changes and cross-claims analysis to identify exclusions currently missed based on stand-alone claim determinations.
In addition to identifying and recovering inappropriately submitted HCRA funds, Penstock was able to provide coding and billing guidance, industry-standard policies and guidelines, and the applicable regulatory references that support operational or system changes required to ensure the accuracy of assessment obligations.
Penstock identified $2,963,502 in surcharge overpayments for the time period under review. By providing the reference documentation and recommendations, the client was able to make systemic changes to prevent future recurrences.
Learn more about Penstock
