Statistical Outliers

Single-test outliers in Montana Medicaid data. These are individual statistical flags — 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 — 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

15

warning

37

info

1,387

Total

1,439

Outliers by Type

Severity Distribution

critical

15 (1.0%)

warning

37 (2.6%)

info

1,387 (96.4%)

1,088 results

criticalCost OutlierScore: 6.7

Cost-per-claim above average for 90837 (Psychotherapy (60 min))

JOHN BREWER (1205113966) bills $232.07/claim for 90837 (Psytx w pt 60 minutes) vs avg $80.89 (+6.7σ). $50,128 across 216 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.

JOHN BREWERPABLOProvider total: $50.1K

criticalCost OutlierScore: 5.9

Cost-per-claim above average for J3490

1366519027 (1366519027) bills $1,374.12/claim for J3490 (Drugs unclassified injection) vs avg $39.33 (+5.9σ). $53,591 across 39 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.

GUAM MEMORIAL HOSPITALOKA TAMUNINGProvider total: $143.2K

criticalCost OutlierScore: 5.1

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

THOMAS ESKELSEN (1861781742) bills $59.90/claim for 90471 (Immunization admin) vs avg $11.28 (+5.1σ). $53,012 across 885 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.

THOMAS ESKELSENGREAT FALLSProvider total: $158.6K

criticalCost OutlierScore: 5.0

Cost-per-claim above average for T1016 (Case Management (per 15 min))

NEW DAY, INC. (1760525992) bills $198.21/claim for T1016 (Case management) vs avg $40.28 (+5.0σ). $1,072,928 across 5,413 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.

NEW DAY, INC.BILLINGSProvider total: $27.7M

criticalCost OutlierScore: 4.8

Cost-per-claim above average for A9270

CENTER FOR MENTAL HEALTH (1144251885) bills $985.26/claim for A9270 (Non-covered item or service) vs avg $41.06 (+4.8σ). $47,292 across 48 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.

CENTER FOR MENTAL HEALTHGREAT FALLSProvider total: $55.2M

criticalCost OutlierScore: 4.8

Cost-per-claim above average for 87340

WESTERN MONTANA CLINIC PC (1740364017) bills $9.38/claim for 87340 (Hepatitis b surface ag ia) vs avg $0.53 (+4.8σ). $19,349 across 2,063 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.

WESTERN MONTANA CLINIC PCMISSOULAProvider total: $1.7M

criticalCost OutlierScore: 4.8

Cost-per-claim above average for 99282 (Emergency Dept Visit (Low Complexity))

US HEALTH DEPT OF HEALTH & HUMAN SERVICES (1548393358) bills $111.84/claim for 99282 (Emergency dept visit sf mdm) vs avg $26.31 (+4.8σ). $30,533 across 273 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.

US HEALTH DEPT OF HEALTH & HUMAN SERVICESCROW AGENCYProvider total: $165.5K

criticalCost OutlierScore: 4.6

Cost-per-claim above average for A0380

ALL SET MEDICS LLC (1609652841) bills $703.39/claim for A0380 (Basic life support mileage) vs avg $113.70 (+4.6σ). $56,975 across 81 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.

ALL SET MEDICS LLCBOZEMANProvider total: $93.2K

criticalCost OutlierScore: 4.6

Cost-per-claim above average for G0480 (Drug Test, Definitive (1-7 classes))

INHEALTH LIFE SCIENCES LLC (1104466994) bills $30.90/claim for G0480 (Drug test def 1-7 classes) vs avg $1.96 (+4.6σ). $91,184 across 2,951 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.

INHEALTH LIFE SCIENCES LLCBOZEMANProvider total: $328.9K

criticalCost OutlierScore: 4.5

Cost-per-claim above average for 90837 (Psychotherapy (60 min))

OPPORTUNITY RESOURCES INC (1255406658) bills $183.74/claim for 90837 (Psytx w pt 60 minutes) vs avg $80.89 (+4.5σ). $235,370 across 1,281 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.

OPPORTUNITY RESOURCES INCMISSOULAProvider total: $48.6M

criticalCost OutlierScore: 4.5

Cost-per-claim above average for 83880

KALISPELL REGIONAL MEDICAL CENTER INC (1417945627) bills $5.30/claim for 83880 (Assay of natriuretic peptide) vs avg $0.54 (+4.5σ). $11,459 across 2,163 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.

KALISPELL REGIONAL MEDICAL CENTER INCKALISPELLProvider total: $8.8M

criticalCost OutlierScore: 4.2

Cost-per-claim above average for T1019

OPPORTUNITY RESOURCES INC (1255406658) bills $1,051.29/claim for T1019 (Personal care ser per 15 min) vs avg $174.67 (+4.2σ). $6,512,722 across 6,195 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.

OPPORTUNITY RESOURCES INCMISSOULAProvider total: $48.6M

criticalCost OutlierScore: 4.0

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

METWEST INC. (1235157280) bills $11.59/claim for 85025 (Complete cbc w/auto diff wbc) vs avg $1.73 (+4.0σ). $16,776 across 1,448 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.

METWEST INC.BILLINGSProvider total: $69.4K

criticalCost OutlierScore: 4.0

Cost-per-claim above average for G0463

1326447939 (1326447939) bills $341.48/claim for G0463 (Hospital outpt clinic visit) vs avg $27.40 (+4.0σ). $72,394 across 212 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.

GUAM HEALTHCARE DEVELOPMENT INCORPORATEDDEDEDOProvider total: $77.8K

warningCost OutlierScore: 4.0

Cost-per-claim above average for 90837 (Psychotherapy (60 min))

KENNETH OLSON (1407927510) bills $171.44/claim for 90837 (Psytx w pt 60 minutes) vs avg $80.89 (+4.0σ). $88,118 across 514 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.

KENNETH OLSONBOZEMANProvider total: $808.4K

warningCost OutlierScore: 3.9

Cost-per-claim above average for T2028

HARRINGTON SURGICAL SUPPLY INC (1801946017) bills $124.53/claim for T2028 (Special supply, nos waiver) vs avg $41.15 (+3.9σ). $270,611 across 2,173 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.

HARRINGTON SURGICAL SUPPLY INCBUTTEProvider total: $978.1K

warningCost OutlierScore: 3.9

Cost-per-claim above average for E0562

BENEFIS COMMUNITY CARE, INC. (1477583011) bills $126.02/claim for E0562 (Humidifier, heated, used with positive airway pressure device) vs avg $26.17 (+3.9σ). $38,059 across 302 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.

BENEFIS COMMUNITY CARE, INC.GREAT FALLSProvider total: $2.4M

warningCost OutlierScore: 3.8

Cost-per-claim above average for 96374

BARRETT HOSPITAL DEVELOPMENT CORPORATION (1326042078) bills $7.44/claim for 96374 (Ther/proph/diag inj iv push) vs avg $2.30 (+3.8σ). $17,295 across 2,325 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.

BARRETT HOSPITAL DEVELOPMENT CORPORATIONDILLONProvider total: $790.0K

warningCost OutlierScore: 3.8

Cost-per-claim above average for 84443 (Thyroid Stimulating Hormone (TSH))

METWEST INC. (1235157280) bills $20.42/claim for 84443 (Assay thyroid stim hormone) vs avg $2.50 (+3.8σ). $20,853 across 1,021 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.

METWEST INC.BILLINGSProvider total: $69.4K

warningCost OutlierScore: 3.7

Cost-per-claim above average for 84443 (Thyroid Stimulating Hormone (TSH))

WESTERN MONTANA CLINIC PC (1740364017) bills $20.02/claim for 84443 (Assay thyroid stim hormone) vs avg $2.50 (+3.7σ). $119,095 across 5,949 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.

WESTERN MONTANA CLINIC PCMISSOULAProvider total: $1.7M

warningCost OutlierScore: 3.7

Cost-per-claim above average for H2012

NEW DAY, INC. (1760525992) bills $289.25/claim for H2012 (Behav hlth day treat, per hr) vs avg $63.38 (+3.7σ). $5,622,704 across 19,439 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.

NEW DAY, INC.BILLINGSProvider total: $27.7M

warningCost OutlierScore: 3.6

Cost-per-claim above average for T2003

REGION IV FAMILY OUTREACH, INC (1447300132) bills $76.42/claim for T2003 (N-et; encounter/trip) vs avg $32.92 (+3.6σ). $150,018 across 1,963 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.

REGION IV FAMILY OUTREACH, INCHELENAProvider total: $7.3M

warningCost OutlierScore: 3.6

Cost-per-claim above average for 87581

WESTERN MONTANA CLINIC PC (1740364017) bills $39.52/claim for 87581 (M.pneumon dna amp probe) vs avg $5.62 (+3.6σ). $16,677 across 422 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.

WESTERN MONTANA CLINIC PCMISSOULAProvider total: $1.7M

warningCost OutlierScore: 3.6

Cost-per-claim above average for S5126

NORTH CENTRAL INDEPENDENT LIVING SERVICES,INC (1518337286) bills $284.18/claim for S5126 (Attendant care service /diem) vs avg $63.25 (+3.6σ). $2,908,574 across 10,235 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.

NORTH CENTRAL INDEPENDENT LIVING SERVICES,INCBLACK EAGLEProvider total: $4.3M

warningCost OutlierScore: 3.6

Cost-per-claim above average for H2035

NEW DAY, INC. (1760525992) bills $186.78/claim for H2035 (A/d tx program, per hour) vs avg $47.66 (+3.6σ). $35,862 across 192 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.

NEW DAY, INC.BILLINGSProvider total: $27.7M

warningCost OutlierScore: 3.5

Cost-per-claim above average for J0131

BOZEMAN HEALTH DEACONESS HOSPITAL (1104295864) bills $12.14/claim for J0131 (Inj, acetaminophen (nos)) vs avg $2.14 (+3.5σ). $26,986 across 2,223 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.

BOZEMAN HEALTH DEACONESS HOSPITALBOZEMANProvider total: $4.5M

warningCost OutlierScore: 3.4

Cost-per-claim above average for S0215

JOB CONNECTION, INC (1336299189) bills $186.74/claim for S0215 (Nonemerg transp mileage) vs avg $26.64 (+3.4σ). $17,927 across 96 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.

JOB CONNECTION, INCBILLINGSProvider total: $5.9M

warningCost OutlierScore: 3.4

Cost-per-claim below average for 90837 (Psychotherapy (60 min))

CONFEDERATED SALISH AND KOOTENAI TRIBES OF THE FLATHEAD RESERVATION (1952402208) bills $4.28/claim for 90837 (Psytx w pt 60 minutes) vs avg $80.89 (-3.4σ). $38,617 across 9,016 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.

CONFEDERATED SALISH AND KOOTENAI TRIBES OF THE FLATHEAD RESERVATIONSAINT IGNATIUSProvider total: $161.1K

warningCost OutlierScore: 3.4

Cost-per-claim above average for E0601 (CPAP Device (Continuous Positive Airway Pressure))

PRICE RITE MEDICAL EQUIPMENT, INC. (1356388771) bills $59.79/claim for E0601 (Continuous positive airway pressure (cpap) device) vs avg $39.25 (+3.4σ). $102,606 across 1,716 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.

PRICE RITE MEDICAL EQUIPMENT, INC.BOZEMANProvider total: $1.0M

warningCost OutlierScore: 3.3

Cost-per-claim above average for A0382

ALL SET MEDICS LLC (1609652841) bills $225.00/claim for A0382 (Basic support routine suppls) vs avg $66.54 (+3.3σ). $18,225 across 81 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.

ALL SET MEDICS LLCBOZEMANProvider total: $93.2K

warningCost OutlierScore: 3.3

Cost-per-claim above average for 72148 (Lumbar Spine MRI without Contrast)

SCLTDI JV, LLC (1659850659) bills $166.61/claim for 72148 (Mri lumbar spine w/o dye) vs avg $36.48 (+3.3σ). $80,637 across 484 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.

SCLTDI JV, LLCBILLINGSProvider total: $102.5K

warningCost OutlierScore: 3.3

Cost-per-claim above average for 99490

FRENCHTOWN FAMILY MEDICAL & WELLNESS, PC (1346807344) bills $54.58/claim for 99490 (Chrnc care mgmt staff 1st 20) vs avg $5.32 (+3.3σ). $62,653 across 1,148 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.

FRENCHTOWN FAMILY MEDICAL & WELLNESS, PCFRENCHTOWNProvider total: $470.7K

warningCost OutlierScore: 3.3

Cost-per-claim above average for E0562

NORCO, INC (1366506024) bills $109.78/claim for E0562 (Humidifier, heated, used with positive airway pressure device) vs avg $26.17 (+3.2σ). $104,732 across 954 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.

NORCO, INCMISSOULAProvider total: $3.8M

warningCost OutlierScore: 3.2

Cost-per-claim above average for 71046 (Chest X-ray (2 views, Frontal and Lateral))

RIVERSIDE FAMILY CLINIC (1255351862) bills $28.02/claim for 71046 (X-ray exam chest 2 views) vs avg $7.83 (+3.2σ). $28,018 across 1,000 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.

RIVERSIDE FAMILY CLINICPOPLARProvider total: $422.4K

warningCost OutlierScore: 3.1

Cost-per-claim above average for 71046 (Chest X-ray (2 views, Frontal and Lateral))

WOLF POINT CLINIC ASSOCIATION INC (1992722904) bills $27.72/claim for 71046 (X-ray exam chest 2 views) vs avg $7.83 (+3.1σ). $31,348 across 1,131 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.

WOLF POINT CLINIC ASSOCIATION INCWOLF POINTProvider total: $520.5K

warningCost OutlierScore: 3.1

Cost-per-claim above average for J2704

RCHP BILLINGS - MISSOULA LLC (1346642899) bills $3.35/claim for J2704 (Inj, propofol, 10 mg) vs avg $0.86 (+3.1σ). $20,629 across 6,150 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.

RCHP BILLINGS - MISSOULA LLCMISSOULAProvider total: $4.0M

warningCost OutlierScore: 3.1

Cost-per-claim above average for 88304

YELLOWSTONE PATHOLOGY INSTITUTE, INC. (1790787935) bills $33.95/claim for 88304 (Tissue exam by pathologist) vs avg $9.06 (+3.1σ). $104,283 across 3,072 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.

YELLOWSTONE PATHOLOGY INSTITUTE, INC.BILLINGSProvider total: $4.4M

warningCost OutlierScore: 3.1

Cost-per-claim below average for D9248

PEDIATRIC DENTAL SPECIALISTS (1730209974) bills $101.16/claim for D9248 (Non-intravenous moderate sedation) vs avg $139.92 (-3.1σ). $14,769 across 146 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.

PEDIATRIC DENTAL SPECIALISTSBILLINGSProvider total: $304.6K

warningCost OutlierScore: 3.1

Cost-per-claim above average for 88342

YELLOWSTONE PATHOLOGY INSTITUTE, INC. (1790787935) bills $76.51/claim for 88342 (Imhchem/imcytchm 1st antb) vs avg $16.03 (+3.1σ). $284,847 across 3,723 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.

YELLOWSTONE PATHOLOGY INSTITUTE, INC.BILLINGSProvider total: $4.4M

warningCost OutlierScore: 3.1

Cost-per-claim above average for A0390

NORTHERN ROCKIES MEDICAL CENTER, INC (1053918243) bills $412.85/claim for A0390 (Advanced life support mileag) vs avg $98.56 (+3.1σ). $16,101 across 39 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.

NORTHERN ROCKIES MEDICAL CENTER, INCCUT BANKProvider total: $497.2K

warningCost OutlierScore: 3.0

Cost-per-claim above average for A0080

CLIENT DEDICATED SERVICES, INC (1538708961) bills $28.36/claim for A0080 (Noninterest escort in non er) vs avg $9.17 (+3.0σ). $121,966 across 4,301 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.

CLIENT DEDICATED SERVICES, INCMISSOULAProvider total: $10.6M

warningCost OutlierScore: 3.0

Cost-per-claim below average for 90837 (Psychotherapy (60 min))

JOANNA LYON (1639369093) bills $12.56/claim for 90837 (Psytx w pt 60 minutes) vs avg $80.89 (-3.0σ). $131,555 across 10,476 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.

JOANNA LYONBOZEMANProvider total: $208.8K

infoSpending SpikeScore: 28.7

Spending spike: 2018-12

CONSUMER DIRECT CARE NETWORK VIRGINIA (1538649983) jumped 28.7x from $194,388 (2018-11) to $5,576,744 (2018-12).

Monthly billing jumped significantly in a single month compared to the prior month. This can indicate new contracts, seasonal variation, or coding changes — not necessarily problematic.

CONSUMER DIRECT CARE NETWORK VIRGINIAMISSOULAProvider total: $2.1B

infoSpending SpikeScore: 17.7

Spending spike: 2018-02

SHADRACH BARNEY (1689947269) jumped 17.7x from $12,484 (2018-01) to $220,582 (2018-02).

Monthly billing jumped significantly in a single month compared to the prior month. This can indicate new contracts, seasonal variation, or coding changes — not necessarily problematic.

SHADRACH BARNEYCOLUMBIA FALLSProvider total: $984.7K

infoHigh VolumeScore: 16.9

Unusually high claim volume for 90837 (Psychotherapy (60 min))

YOUTH DYNAMICS, INC. (1902025067) submitted 65,689 claims for 90837 (Psytx w pt 60 minutes) vs avg 1,814 (+16.9σ).

This provider submits an unusually high number of claims for a specific code compared to peers. This often simply indicates a larger practice or organization.

YOUTH DYNAMICS, INC.BILLINGSProvider total: $24.5M

infoHigh VolumeScore: 13.6

Unusually high claim volume for 90837 (Psychotherapy (60 min))

WESTERN MONTANA MENTAL HEALTH CENTER (1912079328) submitted 53,429 claims for 90837 (Psytx w pt 60 minutes) vs avg 1,814 (+13.6σ).

This provider submits an unusually high number of claims for a specific code compared to peers. This often simply indicates a larger practice or organization.

WESTERN MONTANA MENTAL HEALTH CENTERMISSOULAProvider total: $87.9M

infoSpending SpikeScore: 13.2

Spending spike: 2019-07

COMMUNITY OPTION RESOURCE ENTERPRISES, INC. (1194893115) jumped 13.2x from $13,735 (2019-06) to $180,673 (2019-07).

Monthly billing jumped significantly in a single month compared to the prior month. This can indicate new contracts, seasonal variation, or coding changes — not necessarily problematic.

COMMUNITY OPTION RESOURCE ENTERPRISES, INC.BILLINGSProvider total: $9.8M

infoSpending SpikeScore: 13.0

Spending spike: 2023-03

BSW, INC. (1205977980) jumped 13.0x from $24,306 (2023-02) to $316,101 (2023-03).

Monthly billing jumped significantly in a single month compared to the prior month. This can indicate new contracts, seasonal variation, or coding changes — not necessarily problematic.

BSW, INC.BUTTEProvider total: $20.4M

infoHigh VolumeScore: 12.3

Unusually high claim volume for 99214 (Office Visit, Established Patient (30 min, Moderate Complexi)

SCL HEALTH MEDICAL GROUP - BILLINGS LLC (1508289703) submitted 125,132 claims for 99214 (Office o/p est mod 30 min) vs avg 3,081 (+12.3σ).

This provider submits an unusually high number of claims for a specific code compared to peers. This often simply indicates a larger practice or organization.

SCL HEALTH MEDICAL GROUP - BILLINGS LLCBILLINGSProvider total: $32.1M

infoHigh VolumeScore: 12.2

Unusually high claim volume for 99213 (Office Visit, Established Patient (20 min, Low Complexity))

BILLINGS CLINIC (1376598714) submitted 155,531 claims for 99213 (Office o/p est low 20 min) vs avg 4,320 (+12.2σ).

This provider submits an unusually high number of claims for a specific code compared to peers. This often simply indicates a larger practice or organization.

BILLINGS CLINICBILLINGSProvider total: $53.9M

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