What We Find
A 500-employee manufacturer.
$1.2M in recoverable savings.
This is what a typical engagement looks like. Every number is based on actual claims data, CMS Medicare rates, and market benchmarks. Your dedicated partner delivers this analysis within 30 days of receiving your claims file.
Analysis period: January – December 2025
$12.8M
Annual healthcare spend
across all plan members
2,147
Claims analyzed
every procedure benchmarked
$1.2M
Recoverable savings
9.4% of total spend
Where the Money Goes
Four categories.
One report.
TPA Spread
$390K
32% of total
Admin markup above negotiated rates on high-cost procedures. Your TPA is adding undisclosed fees that exceed market norms.
Billing Errors
$340K
26% of total
Upcoding, unbundling, and modifier abuse across 89 claims. Providers billing for more expensive procedures than performed.
Rate Optimization
$280K
23% of total
Procedures billed above fair market rate (over 200% of Medicare). The same procedure at a nearby facility costs 40–60% less.
Plan Design
$190K
16% of total
Network steering opportunities for imaging and outpatient surgery. Redirecting volume to centers of excellence reduces cost without changing benefits.
Drill-Down
One claim.
$14,234 overcharge.
Here is a single claim from the report, analyzed in full. This is the level of detail your partner applies to every flagged claim.
Medicare Rate
$1,847
Fair Price (140%)
$2,586
Amount Billed
$15,400
Impact
$1,420
Supplies (CPT 99070) billed separately at $1,420 — included in the global surgical package. This charge should be zero.
Impact
$12,814
Primary procedure billed at 836% of Medicare. The plan's RBP rate is 140% of Medicare ($2,586). The provider is demanding $12,814 above market.
Total recoverable on this one claim
$14,234
Multiply this across 89 flagged claims and you see how $1.2M adds up.
Your Partner’s Roadmap
From findings to
recovered dollars.
Your dedicated customer success partner builds this roadmap, executes it alongside you, and reports progress every month. This is not a report you read and file. It is a plan you execute together.
01 — RECOVER
File disputes for top 20 claims
$460K recoverable
Formal disputes with evidence packages for the highest-dollar billing errors and excessive charges. Each dispute includes CMS MRF data, NCCI edit documentation, and a templated demand letter.
02 — RENEGOTIATE
Renegotiate TPA contract terms
$390K annual savings
Armed with benchmark data showing admin spread above market, renegotiate your fee schedule. We provide the comparison data and sit at the table with you.
03 — REDIRECT
Redirect high-cost procedures to COEs
$350K annual savings
Steer imaging and outpatient surgery to in-network centers of excellence with verified fair pricing. No network change required — just smarter referral patterns.
∞ — MONITOR
Monthly monitoring + quarterly review
Prevent recurrence
Your customer success partner reviews every claim monthly and meets quarterly to update the roadmap. New overcharges are caught within 30 days, not 12 months.
This is what your dedicated partner delivers.
Every month.
Not a database. Not a dashboard. A partner who knows your plan, watches every claim, and fights for every dollar.