Shift discovered a provider who was billing antigen therapy incorrectly and leveraged CMS Comprehensive Error Rate Testing (CERT) data to identify services with high improper payment rates. Evidence was then found that the provider was an outlier for a specific antigen service. Shift's customer was then able to identify over half a million dollars in potential recoveries and the health plan was able to educate its providers on correct billing codes, driving future savings across the organization.
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