Statistical Outliers

Single-test outliers in North Dakota 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

warning

info

660

Total

738

Outliers by Type

Severity Distribution

critical

32 (4.3%)

warning

46 (6.2%)

info

660 (89.4%)

574 results

criticalCost OutlierScore: 9.4

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

SPIRIT LAKE TRIBE (1720152457) bills $515.39/claim for 90471 (Immunization admin) vs avg $21.36 (+9.4σ). $737,008 across 1,430 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.

SPIRIT LAKE TRIBEFORT TOTTENProvider total: $765.6K

criticalCost OutlierScore: 9.4

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

SPIRIT LAKE TRIBE (1114472891) bills $686.76/claim for D1206 (Topical fluoride varnish) vs avg $28.41 (+9.4σ). $153,147 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.

SPIRIT LAKE TRIBEFORT TOTTENProvider total: $16.6M

criticalOverutilizationScore: 8.7

Unusually high claims-per-beneficiary ratio

SOUTH CENTRAL HUMAN SERVICE CENTER (1154842185): 40.2 claims/beneficiary (avg 3.1). 1,449 claims, 36 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.

SOUTH CENTRAL HUMAN SERVICE CENTERJAMESTOWNProvider total: $124.7K

criticalCost OutlierScore: 8.0

Cost-per-claim above average for D1110 (Adult Dental Prophylaxis (Teeth Cleaning))

SPIRIT LAKE TRIBE (1114472891) bills $568.89/claim for D1110 (Prophylaxis - adult) vs avg $51.69 (+8.0σ). $10,240 across 18 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.

SPIRIT LAKE TRIBEFORT TOTTENProvider total: $16.6M

criticalCost OutlierScore: 7.8

Cost-per-claim above average for D0120 (Periodic Oral Evaluation (Established Patient))

NORTHLAND HEALTH PARTNERS COMMUNITY HEALTH CENTER (1629481841) bills $364.99/claim for D0120 (Periodic oral evaluation) vs avg $32.08 (+7.8σ). $15,329 across 42 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.

NORTHLAND HEALTH PARTNERS COMMUNITY HEALTH CENTERMINOTProvider total: $29.2K

criticalCost OutlierScore: 7.7

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

FAMILY HEALTH CARE CENTER (1710066352) bills $24.02/claim for 36415 (Coll venous bld venipuncture) vs avg $2.92 (+7.7σ). $481,751 across 20,058 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.

FAMILY HEALTH CARE CENTERFARGOProvider total: $12.7M

criticalCost OutlierScore: 7.2

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

THE HEALING CENTER COUNSELING & CONSULTING SERVICES PLLC (1346987302) bills $698.44/claim for 90837 (Psytx w pt 60 minutes) vs avg $122.72 (+7.2σ). $146,673 across 210 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 HEALING CENTER COUNSELING & CONSULTING SERVICES PLLCFARGOProvider total: $433.6K

criticalOverutilizationScore: 6.5

Unusually high claims-per-beneficiary ratio

NORTHEAST HUMAN SERVICE CENTER (1922529932): 30.8 claims/beneficiary (avg 3.1). 16,863 claims, 548 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.

NORTHEAST HUMAN SERVICE CENTERGRAND FORKSProvider total: $1.7M

criticalOverutilizationScore: 6.1

Unusually high claims-per-beneficiary ratio

EDGEWOOD JAMESTOWN,LLC (1891241139): 29.0 claims/beneficiary (avg 3.1). 7,038 claims, 243 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.

EDGEWOOD JAMESTOWN,LLCGRAND FORKSProvider total: $847.4K

criticalCost OutlierScore: 6.0

Cost-per-claim above average for D0150 (Comprehensive Oral Evaluation (New or Established Patient))

FAMILY HEALTH CARE CENTER (1033281050) bills $231.89/claim for D0150 (Comprehensive oral evaluation) vs avg $41.80 (+6.0σ). $74,204 across 320 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.

FAMILY HEALTH CARE CENTERFARGOProvider total: $1.8M

criticalOverutilizationScore: 5.9

Unusually high claims-per-beneficiary ratio

PRUDENT HOMECARE LLC (1003414913): 28.2 claims/beneficiary (avg 3.1). 2,370 claims, 84 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.

PRUDENT HOMECARE LLCBISMARCKProvider total: $1.8M

criticalOverutilizationScore: 5.6

Unusually high claims-per-beneficiary ratio

GOODSAMARITAN HOME CARE (1366046724): 26.8 claims/beneficiary (avg 3.1). 20,757 claims, 774 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.

GOODSAMARITAN HOME CAREFARGOProvider total: $2.7M

criticalCost OutlierScore: 5.2

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

FORT YATES INDIAN HEALTH SERVICE HOSPITAL (1609851039) bills $447.32/claim for 99213 (Office o/p est low 20 min) vs avg $91.49 (+5.2σ). $5,990,975 across 13,393 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.

FORT YATES INDIAN HEALTH SERVICE HOSPITALFORT YATESProvider total: $10.0M

criticalCost OutlierScore: 5.1

Cost-per-claim above average for Q3014

QUENTIN N BURDICK COMPREHENSIVE HEALTH CARE FACILITY (1952346934) bills $517.72/claim for Q3014 (Telehealth facility fee) vs avg $33.71 (+5.1σ). $8,377,678 across 16,182 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.

QUENTIN N BURDICK COMPREHENSIVE HEALTH CARE FACILITYBELCOURTProvider total: $22.2M

criticalOverutilizationScore: 5.1

Unusually high claims-per-beneficiary ratio

CONVENIENT HOME CARE LLC (1215536685): 24.7 claims/beneficiary (avg 3.1). 8,436 claims, 342 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.

CONVENIENT HOME CARE LLCFARGOProvider total: $835.0K

criticalCost OutlierScore: 5.0

Cost-per-claim above average for 99215 (Office Visit, Established Patient (40 min, High Complexity))

LAKE REGION HUMAN SERVICE CENTER (1669411930) bills $1,237.55/claim for 99215 (Office o/p est hi 40 min) vs avg $189.86 (+5.0σ). $58,165 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.

LAKE REGION HUMAN SERVICE CENTERDEVILS LAKEProvider total: $2.4M

criticalCost OutlierScore: 4.7

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

QUENTIN N BURDICK COMPREHENSIVE HEALTH CARE FACILITY (1952346934) bills $659.29/claim for 99212 (Office o/p est sf 10 min) vs avg $99.33 (+4.7σ). $267,672 across 406 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.

QUENTIN N BURDICK COMPREHENSIVE HEALTH CARE FACILITYBELCOURTProvider total: $22.2M

criticalCost OutlierScore: 4.6

Cost-per-claim above average for 90834 (Psychotherapy (45 min))

NORTHLAND HEALTH PARTNERS COMMUNITY HEALTH CENTER (1710570171) bills $270.99/claim for 90834 (Psytx w pt 45 minutes) vs avg $77.40 (+4.6σ). $146,064 across 539 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.

NORTHLAND HEALTH PARTNERS COMMUNITY HEALTH CENTERMINOTProvider total: $146.1K

criticalCost OutlierScore: 4.2

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

FORT YATES INDIAN HEALTH SERVICE HOSPITAL (1609851039) bills $321.80/claim for D1206 (Topical fluoride varnish) vs avg $28.41 (+4.2σ). $22,204 across 69 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.

FORT YATES INDIAN HEALTH SERVICE HOSPITALFORT YATESProvider total: $10.0M

criticalCost OutlierScore: 4.2

Cost-per-claim above average for 96127 (Brief Emotional/Behavioral Assessment)

PRESENTATION MEDICAL CENTER (1992014518) bills $54.30/claim for 96127 (Brief emotional/behav assmt) vs avg $5.89 (+4.2σ). $72,159 across 1,329 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.

PRESENTATION MEDICAL CENTERROLLAProvider total: $1.7M

criticalCost OutlierScore: 4.1

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

TRINITY HEALTH (1083653752) bills $74.92/claim for 80053 (Comprehen metabolic panel) vs avg $14.76 (+4.1σ). $28,920 across 386 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.

TRINITY HEALTHMINOTProvider total: $18.7M

criticalCost OutlierScore: 4.1

Cost-per-claim above average for 97110 (Therapeutic Exercise (per 15 min))

CHRISTIAN UNITY HOSPITAL CORPORATION (1245216852) bills $140.13/claim for 97110 (Therapeutic exercises) vs avg $37.67 (+4.1σ). $15,975 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.

CHRISTIAN UNITY HOSPITAL CORPORATIONGRAFTONProvider total: $204.8K

criticalCost OutlierScore: 4.0

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

THE HEALING CENTER COUNSELING & CONSULTING SERVICES PLLC (1346987302) bills $962.80/claim for T1016 (Case management) vs avg $129.90 (+4.0σ). $286,914 across 298 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 HEALING CENTER COUNSELING & CONSULTING SERVICES PLLCFARGOProvider total: $433.6K

warningOverutilizationScore: 4.9

Unusually high claims-per-beneficiary ratio

TAMI'S ANGELS, INC. (1588866685): 23.8 claims/beneficiary (avg 3.1). 3,195 claims, 134 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.

TAMI'S ANGELS, INC.FARGOProvider total: $473.5K

warningOverutilizationScore: 4.8

Unusually high claims-per-beneficiary ratio

LOVE AND CARE INC (1013665439): 23.6 claims/beneficiary (avg 3.1). 1,275 claims, 54 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.

LOVE AND CARE INCBISMARCKProvider total: $222.3K

warningOverutilizationScore: 4.8

Unusually high claims-per-beneficiary ratio

SAMUEL SERVICES CORPORATION (1538319942): 23.5 claims/beneficiary (avg 3.1). 1,505 claims, 64 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.

SAMUEL SERVICES CORPORATIONPINEVILLEProvider total: $88.5K

warningOverutilizationScore: 4.8

Unusually high claims-per-beneficiary ratio

BLESSED HOME CARE (1861145443): 23.5 claims/beneficiary (avg 3.1). 12,335 claims, 525 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.

BLESSED HOME CAREGRAND FORKSProvider total: $1.4M

warningOverutilizationScore: 4.6

Unusually high claims-per-beneficiary ratio

SHANGRI-LA HOME CARE (1467153593): 22.8 claims/beneficiary (avg 3.1). 13,037 claims, 573 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.

SHANGRI-LA HOME CAREFARGOProvider total: $2.0M

warningOverutilizationScore: 4.6

Unusually high claims-per-beneficiary ratio

COMMUNITY LIVING SERVICES, INC (1134715691): 22.7 claims/beneficiary (avg 3.1). 22,439 claims, 989 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 LIVING SERVICES, INCFARGOProvider total: $2.0M

warningOverutilizationScore: 4.5

Unusually high claims-per-beneficiary ratio

ALL EMBRACING HOME CARE, LLC (1144844903): 22.2 claims/beneficiary (avg 3.1). 5,012 claims, 226 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.

ALL EMBRACING HOME CARE, LLCTHOMPSONProvider total: $455.3K

warningOverutilizationScore: 4.4

Unusually high claims-per-beneficiary ratio

HAPPY AND SMILE LLC (1487255931): 22.0 claims/beneficiary (avg 3.1). 3,820 claims, 174 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.

HAPPY AND SMILE LLCBISMARCKProvider total: $675.4K

warningOverutilizationScore: 4.2

Unusually high claims-per-beneficiary ratio

EASTER SEALS GOODWILL ND, INC. (1326646704): 20.9 claims/beneficiary (avg 3.1). 10,982 claims, 525 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.

EASTER SEALS GOODWILL ND, INC.MANDANProvider total: $1.0M

warningCost OutlierScore: 4.0

Cost-per-claim above average for D0120 (Periodic Oral Evaluation (Established Patient))

FAMILY HEALTH CARE CENTER (1033281050) bills $202.09/claim for D0120 (Periodic oral evaluation) vs avg $32.08 (+4.0σ). $654,153 across 3,237 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.

FAMILY HEALTH CARE CENTERFARGOProvider total: $1.8M

warningCost OutlierScore: 3.9

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

NORTHLAND HEALTH PARTNERS COMMUNITY HEALTH CENTER (1811581820) bills $361.43/claim for 99213 (Office o/p est low 20 min) vs avg $91.49 (+3.9σ). $78,068 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.

NORTHLAND HEALTH PARTNERS COMMUNITY HEALTH CENTERST JOHNProvider total: $78.1K

warningCost OutlierScore: 3.9

Cost-per-claim above average for 87491 (Chlamydia DNA/RNA Test (Molecular))

1942241351 (1942241351) bills $197.98/claim for 87491 (Chlmyd trach dna amp probe) vs avg $41.82 (+3.9σ). $191,643 across 968 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.

1942241351Provider total: $5.6M

warningCost OutlierScore: 3.9

Cost-per-claim above average for 74177 (CT Abdomen and Pelvis with Contrast)

MERCY MEDICAL CENTER (1902824576) bills $2,452.24/claim for 74177 (Ct abd & pelvis w/contrast) vs avg $300.16 (+3.9σ). $31,879 across 13 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 MEDICAL CENTERWILLISTONProvider total: $4.0M

warningOverutilizationScore: 3.9

Unusually high claims-per-beneficiary ratio

MKL LLC (1134646052): 19.6 claims/beneficiary (avg 3.1). 3,562 claims, 182 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.

MKL LLCRUGBYProvider total: $223.8K

warningOverutilizationScore: 3.8

Unusually high claims-per-beneficiary ratio

SHAREHOUSE GRAND FORKS (1992462774): 19.4 claims/beneficiary (avg 3.1). 11,805 claims, 609 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.

SHAREHOUSE GRAND FORKSGRAND FORKSProvider total: $4.1M

warningCost OutlierScore: 3.8

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

ALTRU HEALTH SYSTEM (1114485315) bills $1,113.37/claim for A0427 (Als1-emergency) vs avg $399.06 (+3.8σ). $14,474 across 13 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.

ALTRU HEALTH SYSTEMGRAND FORKSProvider total: $490.7K

warningOverutilizationScore: 3.7

Unusually high claims-per-beneficiary ratio

EDGEWOOD SARTELL LLC (1093253346): 18.8 claims/beneficiary (avg 3.1). 48,201 claims, 2,566 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.

EDGEWOOD SARTELL LLCGRAND FORKSProvider total: $7.1M

warningOverutilizationScore: 3.7

Unusually high claims-per-beneficiary ratio

CARING HAND HOMECARE LLC (1003419748): 18.7 claims/beneficiary (avg 3.1). 1,796 claims, 96 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.

CARING HAND HOMECARE LLCFARGOProvider total: $312.8K

warningCost OutlierScore: 3.6

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

UPPER VALLEY SPECIAL EDUCATION (1043224744) bills $14.65/claim for 92507 (Tx sp lang voice comm indiv) vs avg $61.11 (-3.6σ). $41,616 across 2,840 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.

UPPER VALLEY SPECIAL EDUCATIONGRAFTONProvider total: $136.5K

warningCost OutlierScore: 3.6

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

NORTHWOOD DEACONESS HEALTH CENTER (1356449136) bills $173.82/claim for 97530 (Therapeutic activities) vs avg $64.36 (+3.6σ). $73,180 across 421 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.

NORTHWOOD DEACONESS HEALTH CENTERNORTHWOODProvider total: $119.8K

warningCost OutlierScore: 3.5

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

TRENTON INDIAN SERVICE AREA (1568574036) bills $333.39/claim for 99213 (Office o/p est low 20 min) vs avg $91.49 (+3.5σ). $228,038 across 684 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.

TRENTON INDIAN SERVICE AREATRENTONProvider total: $234.9K

warningOverutilizationScore: 3.5

Unusually high claims-per-beneficiary ratio

GRACE HOME CARE LLC (1801569009): 17.8 claims/beneficiary (avg 3.1). 1,068 claims, 60 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.

GRACE HOME CARE LLCBISMARCKProvider total: $105.1K

warningOverutilizationScore: 3.4

Unusually high claims-per-beneficiary ratio

FARGO MAPLE VIEW LLC (1922605310): 17.7 claims/beneficiary (avg 3.1). 24,740 claims, 1,395 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.

FARGO MAPLE VIEW LLCFARGOProvider total: $4.0M

warningCost OutlierScore: 3.4

Cost-per-claim above average for 83036 (Hemoglobin A1c (Diabetes Monitoring))

1942241351 (1942241351) bills $28.12/claim for 83036 (Hemoglobin glycosylated a1c) vs avg $8.02 (+3.4σ). $22,494 across 800 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.

1942241351Provider total: $5.6M

warningCost OutlierScore: 3.3

Cost-per-claim above average for 90834 (Psychotherapy (45 min))

GOOD ROAD RECOVERY CENTER (1629544267) bills $218.64/claim for 90834 (Psytx w pt 45 minutes) vs avg $77.40 (+3.3σ). $64,937 across 297 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.

GOOD ROAD RECOVERY CENTERBISMARCKProvider total: $1.1M

warningCost OutlierScore: 3.3

Cost-per-claim above average for H2035

GOOD ROAD RECOVERY CENTER (1629544267) bills $220.83/claim for H2035 (A/d tx program, per hour) vs avg $84.43 (+3.3σ). $129,405 across 586 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.

GOOD ROAD RECOVERY CENTERBISMARCKProvider total: $1.1M

warningCost OutlierScore: 3.2

Cost-per-claim above average for D1110 (Adult Dental Prophylaxis (Teeth Cleaning))

NORTHLAND HEALTH PARTNERS COMMUNITY HEALTH CENTER (1629481841) bills $257.14/claim for D1110 (Prophylaxis - adult) vs avg $51.69 (+3.2σ). $12,600 across 49 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.

NORTHLAND HEALTH PARTNERS COMMUNITY HEALTH CENTERMINOTProvider total: $29.2K

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Statistical Outliers

Single-test outliers in North Dakota Medicaid data. These are individual statistical flags — most are informational.