Concourse Sentinel

Medicaid Integrity Analytics

πŸ“ŠOverviewπŸ₯ProvidersπŸ’ŠProcedures🚨WatchlistπŸ”Statistical Outliersβš–οΈCompareπŸ“ˆTrendsπŸ—ΊοΈGeography

Cross-Dataset

πŸ•ΈοΈEntity Networks🏠Home Healthβ›”Exclusions (LEIE)πŸ“‹Context & Disclaimers
πŸ‡ΊπŸ‡ΈAll States
by Concourse

Data: CMS T-MSIS 2018-2024

Source: opendata.hhs.gov

Statistical Outliers

Single-test outliers in Missouri Medicaid data. These are individual statistical flags β€” most are informational.

Important context: These findings identify statistically unusual billing patterns, not determinations of wrongdoing. Cost-per-claim comparisons may flag hospital outpatient departments whose reimbursements include facility fees, bundled services, or all-inclusive rates. High claims-per-beneficiary ratios may reflect legitimate care patterns at behavioral health facilities, pediatric specialty centers, or residential care programs. Additional investigation and clinical context are required before drawing any conclusions.

For provider level analytics using multiple independent tests, see the Watchlist β€” which flags providers only when 2+ different detection methods agree. These single-test outliers below are primarily informational; only Cost Outliers and Overutilization are flagged as critical/warning.

critical

402

warning

609

info

6,390

Total

7,401

Outliers by Type
Severity Distribution
critical
402 (5.4%)
warning
609 (8.2%)
info
6,390 (86.3%)
5,640 results
criticalOverutilizationScore: 73.2

Unusually high claims-per-beneficiary ratio

LORI WILLIAMS (1952915910): 497.3 claims/beneficiary (avg 3.2). 288,957 claims, 581 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

LORI WILLIAMSSAINT LOUISProvider total: $716.8K
criticalCost OutlierScore: 17.1

Cost-per-claim above average for 85018

MERCY HOSPITAL JOPLIN (1700112745) bills $197.11/claim for 85018 (Hemoglobin) vs avg $3.91 (+17.1Οƒ). $11,235 across 57 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

MERCY HOSPITAL JOPLINJOPLINProvider total: $46.7M
criticalCost OutlierScore: 16.6

Cost-per-claim above average for 92015

CARESTL HEALTH (1972596088) bills $109.65/claim for 92015 (Determine refractive state) vs avg $5.92 (+16.6Οƒ). $223,129 across 2,035 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

CARESTL HEALTHSAINT LOUISProvider total: $6.7M
criticalOverutilizationScore: 14.6

Unusually high claims-per-beneficiary ratio

AT HOME CARE ST. LOUIS CDS (1659629301): 101.6 claims/beneficiary (avg 3.2). 918,636 claims, 9,046 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

AT HOME CARE ST. LOUIS CDSBRIDGETONProvider total: $14.5M
criticalCost OutlierScore: 14.5

Cost-per-claim above average for 99211 (Office Visit, Established Patient (May not require physician)

SAINT LUKES HOSPITAL OF CHILLICOTHE (1912948308) bills $433.68/claim for 99211 (Off/op est may x req phy/qhp) vs avg $19.53 (+14.5Οƒ). $148,754 across 343 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

SAINT LUKES HOSPITAL OF CHILLICOTHECHILLICOTHEProvider total: $6.1M
criticalCost OutlierScore: 13.2

Cost-per-claim above average for 81002 (Urinalysis without Microscopy)

SSM HEALTH CARE ST. LOUIS (1871665380) bills $527.34/claim for 81002 (Urinalysis nonauto w/o scope) vs avg $9.59 (+13.2Οƒ). $29,004 across 55 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

SSM HEALTH CARE ST. LOUISLAKE ST LOUISProvider total: $8.9M
criticalCost OutlierScore: 12.6

Cost-per-claim above average for 97112

CURATORS OF THE UNIVERSITY OF MISSOURI (1699769901) bills $716.43/claim for 97112 (Neuromuscular reeducation) vs avg $15.92 (+12.6Οƒ). $1,892,808 across 2,642 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

CURATORS OF THE UNIVERSITY OF MISSOURICOLUMBIAProvider total: $135.9M
criticalCost OutlierScore: 12.5

Cost-per-claim above average for 99213 (Office Visit, Established Patient (20 min, Low Complexity))

MERCY HOSPITALS EAST COMMUNITIES (1285664177) bills $433.43/claim for 99213 (Office o/p est low 20 min) vs avg $52.70 (+12.5Οƒ). $44,643 across 103 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

MERCY HOSPITALS EAST COMMUNITIESWASHINGTONProvider total: $25.3M
criticalCost OutlierScore: 12.4

Cost-per-claim above average for 90471 (Immunization Administration (Injection))

ST. LOUIS CHILDREN'S HOSPITAL (1992727663) bills $474.06/claim for 90471 (Immunization admin) vs avg $16.36 (+12.4Οƒ). $10,903 across 23 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

ST. LOUIS CHILDREN'S HOSPITALSAINT LOUISProvider total: $66.9M
criticalCost OutlierScore: 12.3

Cost-per-claim above average for T1002

ELM PLACE LLC (1902098825) bills $683.98/claim for T1002 (Rn services up to 15 minutes) vs avg $54.83 (+12.3Οƒ). $32,147 across 47 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

ELM PLACE LLCSWEET SPRINGSProvider total: $301.1K
criticalCost OutlierScore: 12.0

Cost-per-claim above average for 90734

MERCY HOSPITALS EAST COMMUNITIES (1427098169) bills $72.57/claim for 90734 (Menacwyd/menacwycrm vacc im) vs avg $7.00 (+12.0Οƒ). $15,893 across 219 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

MERCY HOSPITALS EAST COMMUNITIESSAINT LOUISProvider total: $56.5M
criticalCost OutlierScore: 11.2

Cost-per-claim above average for T2016

HBCS, INC. (1548509458) bills $3,873.98/claim for T2016 (Habil res waiver per diem) vs avg $459.34 (+11.2Οƒ). $9,545,496 across 2,464 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

HBCS, INC.CLEVELANDProvider total: $10.6M
criticalCost OutlierScore: 11.2

Cost-per-claim above average for 90651 (HPV Vaccine (9-Valent))

MERCY HOSPITALS EAST COMMUNITIES (1427098169) bills $60.65/claim for 90651 (9vhpv vaccine 2/3 dose im) vs avg $6.68 (+11.2Οƒ). $42,760 across 705 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

MERCY HOSPITALS EAST COMMUNITIESSAINT LOUISProvider total: $56.5M
criticalCost OutlierScore: 11.1

Cost-per-claim above average for 97535

CURATORS OF THE UNIVERSITY OF MISSOURI (1699769901) bills $561.87/claim for 97535 (Self care mngment training) vs avg $19.67 (+11.1Οƒ). $300,599 across 535 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

CURATORS OF THE UNIVERSITY OF MISSOURICOLUMBIAProvider total: $135.9M
criticalCost OutlierScore: 11.1

Cost-per-claim above average for 82728 (Ferritin (Iron Storage) Level)

ST. LOUIS CHILDREN'S HOSPITAL (1992727663) bills $449.56/claim for 82728 (Assay of ferritin) vs avg $8.76 (+11.1Οƒ). $78,673 across 175 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

ST. LOUIS CHILDREN'S HOSPITALSAINT LOUISProvider total: $66.9M
criticalCost OutlierScore: 11.0

Cost-per-claim above average for 90670

GITA MALUR (1578698924) bills $98.55/claim for 90670 (Pcv13 vaccine im) vs avg $7.76 (+11.0Οƒ). $12,121 across 123 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

GITA MALURSAINT LOUISProvider total: $721.6K
criticalCost OutlierScore: 10.9

Cost-per-claim above average for A0427 (ALS Emergency Ambulance Transport)

ST. LOUIS CHILDREN'S HOSPITAL (1992727663) bills $1,599.63/claim for A0427 (Als1-emergency) vs avg $203.33 (+11.0Οƒ). $631,853 across 395 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

ST. LOUIS CHILDREN'S HOSPITALSAINT LOUISProvider total: $66.9M
criticalCost OutlierScore: 10.8

Cost-per-claim above average for 83540

THE CHILDREN'S MERCY HOSPITAL (1366515488) bills $206.87/claim for 83540 (Assay of iron) vs avg $4.11 (+10.8Οƒ). $35,375 across 171 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

THE CHILDREN'S MERCY HOSPITALKANSAS CITYProvider total: $221.2M
criticalCost OutlierScore: 10.6

Cost-per-claim above average for 36415 (Blood Draw (Venipuncture))

PERRY COUNTY HEALTH SYSTEM (1982699328) bills $275.42/claim for 36415 (Coll venous bld venipuncture) vs avg $7.92 (+10.6Οƒ). $374,020 across 1,358 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

PERRY COUNTY HEALTH SYSTEMPERRYVILLEProvider total: $7.4M
criticalCost OutlierScore: 10.4

Cost-per-claim above average for 90633

MERCY HOSPITALS EAST COMMUNITIES (1427098169) bills $48.89/claim for 90633 (Hepa vacc ped/adol 2 dose im) vs avg $6.84 (+10.4Οƒ). $53,245 across 1,089 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

MERCY HOSPITALS EAST COMMUNITIESSAINT LOUISProvider total: $56.5M
criticalCost OutlierScore: 10.2

Cost-per-claim above average for 85025 (Complete Blood Count (CBC) with Differential)

SSM AUDRAIN HEALTH CARE, INC (1952390122) bills $414.39/claim for 85025 (Complete cbc w/auto diff wbc) vs avg $22.87 (+10.2Οƒ). $77,076 across 186 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

SSM AUDRAIN HEALTH CARE, INCMEXICOProvider total: $1.0M
criticalCost OutlierScore: 10.2

Cost-per-claim above average for 99188

1457469637 (1457469637) bills $172.36/claim for 99188 (App topical fluoride varnish) vs avg $18.67 (+10.2Οƒ). $33,782 across 196 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

1457469637Provider total: $543.6K
criticalCost OutlierScore: 10.2

Cost-per-claim above average for 3008F

WT REGIONAL MEDICAL ASSOCIATES (1477870467) bills $47.13/claim for 3008F vs avg $0.45 (+10.1Οƒ). $11,783 across 250 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

WT REGIONAL MEDICAL ASSOCIATESCARUTHERSVILLEProvider total: $533.4K
criticalCost OutlierScore: 10.2

Cost-per-claim above average for 73630 (Foot X-ray (3+ views))

SSM HEALTH CARE ST. LOUIS (1962572396) bills $220.76/claim for 73630 (X-ray exam of foot) vs avg $15.63 (+10.2Οƒ). $26,050 across 118 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

SSM HEALTH CARE ST. LOUISSAINT LOUISProvider total: $50.1M
criticalCost OutlierScore: 10.1

Cost-per-claim above average for 99213 (Office Visit, Established Patient (20 min, Low Complexity))

MERCY HOSPITAL JOPLIN (1700112745) bills $361.62/claim for 99213 (Office o/p est low 20 min) vs avg $52.70 (+10.1Οƒ). $513,134 across 1,419 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

MERCY HOSPITAL JOPLINJOPLINProvider total: $46.7M
criticalCost OutlierScore: 10.1

Cost-per-claim above average for 99213 (Office Visit, Established Patient (20 min, Low Complexity))

MERCY HOSPITAL AURORA (1467543090) bills $361.06/claim for 99213 (Office o/p est low 20 min) vs avg $52.70 (+10.1Οƒ). $11,554 across 32 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

MERCY HOSPITAL AURORAAURORAProvider total: $9.9M
criticalCost OutlierScore: 9.8

Cost-per-claim above average for 80307 (Drug Testing, Presumptive (Chemistry Analyzers))

PERRY COUNTY HEALTH SYSTEM (1982699328) bills $723.59/claim for 80307 (Drug test prsmv chem anlyzr) vs avg $61.16 (+9.8Οƒ). $10,854 across 15 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

PERRY COUNTY HEALTH SYSTEMPERRYVILLEProvider total: $7.4M
criticalCost OutlierScore: 9.4

Cost-per-claim above average for 97530 (Therapeutic Activities (per 15 min))

SAINT FRANCIS MEDICAL CENTER (1467412726) bills $422.59/claim for 97530 (Therapeutic activities) vs avg $28.54 (+9.4Οƒ). $12,678 across 30 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

SAINT FRANCIS MEDICAL CENTERCAPE GIRARDEAUProvider total: $56.4M
criticalOverutilizationScore: 9.4

Unusually high claims-per-beneficiary ratio

COMMUNITY RESIDENCE, INC. (1669479150): 66.7 claims/beneficiary (avg 3.2). 13,339 claims, 200 beneficiaries.

The ratio of claims to unique patients is unusually high, suggesting each patient receives many more services than average. May indicate overutilization or inappropriate repeat billing.

COMMUNITY RESIDENCE, INC.MOUNT VERNONProvider total: $157.2K
criticalCost OutlierScore: 9.0

Cost-per-claim above average for T2021

HBCS, INC. (1548509458) bills $977.23/claim for T2021 (Day habil waiver per 15 min) vs avg $194.09 (+9.0Οƒ). $1,023,158 across 1,047 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

HBCS, INC.CLEVELANDProvider total: $10.6M
criticalCost OutlierScore: 8.9

Cost-per-claim above average for T2001

TIFFANY BURNS (1578025540) bills $1,200.55/claim for T2001 (N-et; patient attend/escort) vs avg $156.57 (+8.9Οƒ). $418,992 across 349 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

TIFFANY BURNSJEFFERSON CITYProvider total: $7.7M
criticalCost OutlierScore: 8.9

Cost-per-claim above average for 90853 (Group Psychotherapy)

MERCY HOSPITALS EAST COMMUNITIES (1285664177) bills $274.79/claim for 90853 (Group psychotherapy) vs avg $23.71 (+8.9Οƒ). $12,365 across 45 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

MERCY HOSPITALS EAST COMMUNITIESWASHINGTONProvider total: $25.3M
criticalCost OutlierScore: 8.5

Cost-per-claim above average for 92508 (Speech-Language Therapy (Group))

LORMAX REHABILITATION INC (1508917865) bills $69.93/claim for 92508 (Tx sp lang voice comm group) vs avg $9.75 (+8.5Οƒ). $67,830 across 970 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

LORMAX REHABILITATION INCARNOLDProvider total: $9.0M
criticalCost OutlierScore: 8.5

Cost-per-claim above average for 99204 (Office Visit, New Patient (45 min, Moderate Complexity))

MISSOURI DELTA MEDICAL CENTER (1134430176) bills $526.57/claim for 99204 (Office o/p new mod 45 min) vs avg $101.87 (+8.5Οƒ). $38,966 across 74 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

MISSOURI DELTA MEDICAL CENTERSIKESTONProvider total: $1.9M
criticalCost OutlierScore: 8.4

Cost-per-claim above average for 87880 (Rapid Strep A Test (Optical/Immunoassay))

MERCY HOSPITAL JEFFERSON (1508859661) bills $353.14/claim for 87880 (Strep a assay w/optic) vs avg $25.10 (+8.4Οƒ). $43,436 across 123 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

MERCY HOSPITAL JEFFERSONFESTUSProvider total: $27.8M
criticalCost OutlierScore: 8.3

Cost-per-claim above average for 99213 (Office Visit, Established Patient (20 min, Low Complexity))

MERCY HOSPITAL LEBANON (1447284898) bills $306.74/claim for 99213 (Office o/p est low 20 min) vs avg $52.70 (+8.3Οƒ). $219,934 across 717 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

MERCY HOSPITAL LEBANONLEBANONProvider total: $32.6M
criticalCost OutlierScore: 8.2

Cost-per-claim above average for D1206 (Topical Fluoride Varnish Application)

JANE GROVE (1023136090) bills $127.25/claim for D1206 (Topical fluoride varnish) vs avg $21.67 (+8.2Οƒ). $59,552 across 468 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

JANE GROVEKANSAS CITYProvider total: $75.3K
criticalCost OutlierScore: 8.1

Cost-per-claim above average for 97116 (Gait Training (per 15 min))

TRUMAN MEDICAL CENTER, INCORPORATED (1376686600) bills $54.68/claim for 97116 (Gait training therapy) vs avg $5.80 (+8.1Οƒ). $18,210 across 333 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

TRUMAN MEDICAL CENTER, INCORPORATEDKANSAS CITYProvider total: $72.7M
criticalCost OutlierScore: 7.9

Cost-per-claim above average for 87880 (Rapid Strep A Test (Optical/Immunoassay))

SALEM MEMORIAL HOSPITAL (1639177561) bills $332.86/claim for 87880 (Strep a assay w/optic) vs avg $25.10 (+7.9Οƒ). $42,607 across 128 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

SALEM MEMORIAL HOSPITALSALEMProvider total: $7.6M
criticalCost OutlierScore: 7.7

Cost-per-claim above average for 99284 (Emergency Dept Visit (Moderate/High Complexity))

SSM AUDRAIN HEALTH CARE, INC (1952390122) bills $500.37/claim for 99284 (Emergency dept visit mod mdm) vs avg $92.95 (+7.7Οƒ). $137,102 across 274 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

SSM AUDRAIN HEALTH CARE, INCMEXICOProvider total: $1.0M
criticalCost OutlierScore: 7.6

Cost-per-claim above average for 87880 (Rapid Strep A Test (Optical/Immunoassay))

MERCY HOSPITAL LEBANON (1447284898) bills $319.57/claim for 87880 (Strep a assay w/optic) vs avg $25.10 (+7.6Οƒ). $219,862 across 688 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

MERCY HOSPITAL LEBANONLEBANONProvider total: $32.6M
criticalCost OutlierScore: 7.5

Cost-per-claim above average for T1001

BLESS HEALTH LLC (1841657988) bills $214.82/claim for T1001 (Nursing assessment/evaluatn) vs avg $50.02 (+7.5Οƒ). $109,985 across 512 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

BLESS HEALTH LLCSAINT LOUISProvider total: $3.0M
criticalCost OutlierScore: 7.1

Cost-per-claim above average for 81003 (Urinalysis by Dipstick (Automated))

1457361024 (1457361024) bills $272.88/claim for 81003 (Urinalysis auto w/o scope) vs avg $16.26 (+7.1Οƒ). $31,109 across 114 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

1457361024Provider total: $3.8M
criticalCost OutlierScore: 7.1

Cost-per-claim above average for 92507 (Speech-Language Therapy (Individual))

SOUTHEAST HOSPITAL (1811006661) bills $374.78/claim for 92507 (Tx sp lang voice comm indiv) vs avg $50.12 (+7.1Οƒ). $83,577 across 223 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

SOUTHEAST HOSPITALCAPE GIRARDEAUProvider total: $34.7M
criticalCost OutlierScore: 7.1

Cost-per-claim above average for 80053 (Comprehensive Metabolic Panel (14 tests))

1457361024 (1457361024) bills $267.24/claim for 80053 (Comprehen metabolic panel) vs avg $28.48 (+7.1Οƒ). $174,509 across 653 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

1457361024Provider total: $3.8M
criticalCost OutlierScore: 7.0

Cost-per-claim above average for A4253 (Blood Glucose Test Strips (per 50))

REHAB SPECIALTY MEDICAL, INC. (1992842058) bills $79.73/claim for A4253 (Blood glucose/reagent strips) vs avg $6.66 (+7.0Οƒ). $58,843 across 738 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

REHAB SPECIALTY MEDICAL, INC.JEFFERSON CITYProvider total: $19.7M
criticalCost OutlierScore: 7.0

Cost-per-claim above average for 99212 (Office Visit, Established Patient (10 min, Straightforward))

MERCY HOSPITAL JEFFERSON (1508859661) bills $235.34/claim for 99212 (Office o/p est sf 10 min) vs avg $40.58 (+7.0Οƒ). $29,182 across 124 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

MERCY HOSPITAL JEFFERSONFESTUSProvider total: $27.8M
criticalCost OutlierScore: 7.0

Cost-per-claim above average for X4006

PINNACLE REGIONAL HOSPITAL, LLC (1730178864) bills $22,663.83/claim for X4006 (Code X4006) vs avg $1,280.21 (+7.0Οƒ). $929,217 across 41 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

PINNACLE REGIONAL HOSPITAL, LLCBOONVILLEProvider total: $2.3M
criticalCost OutlierScore: 7.0

Cost-per-claim above average for 82947 (Blood Glucose Test)

SSM HEALTH CARE ST. LOUIS (1962572396) bills $277.30/claim for 82947 (Assay glucose blood quant) vs avg $12.33 (+7.0Οƒ). $26,343 across 95 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

SSM HEALTH CARE ST. LOUISSAINT LOUISProvider total: $50.1M
criticalCost OutlierScore: 6.9

Cost-per-claim above average for A4657

DIALYSIS CLINIC INC. (1568495943) bills $28.05/claim for A4657 (Syringe w/wo needle) vs avg $1.13 (+6.9Οƒ). $85,427 across 3,045 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

DIALYSIS CLINIC INC.WEST PLAINSProvider total: $354.0K
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