Statistical Outliers

Single-test outliers in Arkansas 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

144

warning

319

info

4,147

Total

4,610

Outliers by Type

Severity Distribution

critical

144 (3.1%)

warning

319 (6.9%)

info

4,147 (90.0%)

3,506 results

criticalCost OutlierScore: 19.3

Cost-per-claim above average for 99214 (Office Visit, Established Patient (30 min, Moderate Complexi)

CHARLES TODD (1275619876) bills $507.99/claim for 99214 (Office o/p est mod 30 min) vs avg $40.65 (+19.3σ). $28,447 across 56 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.

CHARLES TODDCONWAYProvider total: $115.4K

criticalCost OutlierScore: 15.9

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

SGOH ACQUISITION INC (1568643005) bills $117.27/claim for 87880 (Strep a assay w/optic) vs avg $8.24 (+16.0σ). $157,734 across 1,345 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.

SGOH ACQUISITION INCGRAVETTEProvider total: $10.8M

criticalCost OutlierScore: 14.5

Cost-per-claim above average for 99214 (Office Visit, Established Patient (30 min, Moderate Complexi)

CHARLES TODD, PA (1033295639) bills $393.25/claim for 99214 (Office o/p est mod 30 min) vs avg $40.65 (+14.5σ). $13,371 across 34 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.

CHARLES TODD, PACONWAYProvider total: $25.5K

criticalCost OutlierScore: 12.1

Cost-per-claim above average for 87804 (Rapid Influenza Test (Optical/Immunoassay))

SGOH ACQUISITION INC (1568643005) bills $120.57/claim for 87804 (Influenza assay w/optic) vs avg $11.07 (+12.1σ). $36,775 across 305 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.

SGOH ACQUISITION INCGRAVETTEProvider total: $10.8M

criticalCost OutlierScore: 11.3

Cost-per-claim above average for 92014

CHARLES TODD (1275619876) bills $251.87/claim for 92014 (Compre oph exam est pt 1/>) vs avg $46.03 (+11.3σ). $27,958 across 111 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.

CHARLES TODDCONWAYProvider total: $115.4K

criticalCost OutlierScore: 9.6

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

CHICOT MEMORIAL MEDICAL CENTER (1235453192) bills $216.00/claim for 90853 (Group psychotherapy) vs avg $38.95 (+9.6σ). $41,255 across 191 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.

CHICOT MEMORIAL MEDICAL CENTERLAKE VILLAGEProvider total: $1.5M

criticalCost OutlierScore: 9.1

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

NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC (1447581673) bills $210.54/claim for 80053 (Comprehen metabolic panel) vs avg $12.95 (+9.1σ). $129,482 across 615 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.

NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INCJONESBOROProvider total: $387.8K

criticalCost OutlierScore: 8.4

Cost-per-claim above average for H2015

PALCO, INC. (1801276738) bills $234.30/claim for H2015 (Comp comm supp svc, 15 min) vs avg $70.50 (+8.4σ). $906,493 across 3,869 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.

PALCO, INC.MAUMELLEProvider total: $435.6M

criticalCost OutlierScore: 8.0

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

BRYAN DARLING (1679788426) bills $45.57/claim for D1206 (Topical fluoride varnish) vs avg $18.36 (+8.0σ). $14,765 across 324 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.

BRYAN DARLINGJONESBOROProvider total: $82.9K

criticalCost OutlierScore: 7.9

Cost-per-claim above average for Q5001

ST BERNARDS HOSPITAL, INC. (1538197389) bills $122.72/claim for Q5001 (Hospice or home hlth in home) vs avg $3.20 (+7.9σ). $165,913 across 1,352 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 BERNARDS HOSPITAL, INC.JONESBOROProvider total: $165.9K

criticalCost OutlierScore: 7.2

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

TERRI EUBANKS (1306960737) bills $48.02/claim for D0120 (Periodic oral evaluation) vs avg $24.54 (+7.2σ). $86,633 across 1,804 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.

TERRI EUBANKSDERMOTTProvider total: $783.9K

criticalCost OutlierScore: 7.0

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

NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC. (1033491519) bills $164.57/claim for 80053 (Comprehen metabolic panel) vs avg $12.95 (+7.0σ). $97,753 across 594 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.

NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC.JONESBOROProvider total: $397.1K

criticalCost OutlierScore: 6.7

Cost-per-claim above average for 96372

CROSSETT HEALTH FOUNDATION (1952308215) bills $110.55/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $7.96 (+6.7σ). $52,513 across 475 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.

CROSSETT HEALTH FOUNDATIONCROSSETTProvider total: $3.4M

criticalCost OutlierScore: 6.6

Cost-per-claim above average for 99233 (Subsequent Hospital Care (High Complexity))

THE CENTER FOR PEDIATRICS AND ADOLESCENT MEDICINE (1043225709) bills $187.44/claim for 99233 (Sbsq hosp ip/obs high 50) vs avg $38.70 (+6.6σ). $125,394 across 669 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 CENTER FOR PEDIATRICS AND ADOLESCENT MEDICINEFORT SMITHProvider total: $2.7M

criticalCost OutlierScore: 6.6

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

VAN BUREN HMA LLC (1386687036) bills $19.47/claim for 36415 (Coll venous bld venipuncture) vs avg $1.98 (+6.6σ). $14,405 across 740 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.

VAN BUREN HMA LLCVAN BURENProvider total: $398.0K

criticalCost OutlierScore: 6.6

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

1972577104 (1972577104) bills $107.46/claim for 99213 (Office o/p est low 20 min) vs avg $24.10 (+6.6σ). $37,287 across 347 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.

GOVERNMENT OF GUAM DEPARTMENT OF ADMINISTRATIONDEDEDOProvider total: $43.9K

criticalCost OutlierScore: 6.5

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

INIS BARDELLA (1124084926) bills $106.53/claim for 99213 (Office o/p est low 20 min) vs avg $24.10 (+6.6σ). $18,216 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.

INIS BARDELLAMAGNOLIAProvider total: $21.7K

criticalCost OutlierScore: 6.5

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

1629041546 (1629041546) bills $106.15/claim for 99213 (Office o/p est low 20 min) vs avg $24.10 (+6.5σ). $19,000 across 179 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.

GOVERNMENT OF GUAM DEPARTMENT OF ADMINISTRATIONINARAJANProvider total: $23.6K

criticalCost OutlierScore: 6.5

Cost-per-claim above average for 97532

PATHFINDER, INC. (1326004466) bills $83.47/claim for 97532 (Code 97532) vs avg $27.35 (+6.5σ). $110,596 across 1,325 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.

PATHFINDER, INC.JACKSONVILLEProvider total: $69.9M

criticalCost OutlierScore: 6.3

Cost-per-claim above average for J7030

BAPTIST MEMORIAL HOSPITAL - CRITTENDEN INC (1437634524) bills $68.81/claim for J7030 (Normal saline solution infus) vs avg $2.99 (+6.3σ). $33,440 across 486 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.

BAPTIST MEMORIAL HOSPITAL - CRITTENDEN INCWEST MEMPHISProvider total: $4.1M

criticalCost OutlierScore: 6.3

Cost-per-claim above average for H2016

DIVERSIFIED CHILDREN YOUTH & FAMILIES DEVELOPMENT PROGRAM (1851654909) bills $15,826.77/claim for H2016 (Comp comm supp svc, per diem) vs avg $1,269.82 (+6.3σ). $14,354,879 across 907 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.

DIVERSIFIED CHILDREN YOUTH & FAMILIES DEVELOPMENT PROGRAMLITTLE ROCKProvider total: $14.4M

criticalCost OutlierScore: 6.3

Cost-per-claim above average for 85027 (Complete Blood Count (CBC) without Differential)

HARRISON DIALYSIS LLC (1659522076) bills $26.43/claim for 85027 (Complete cbc automated) vs avg $5.20 (+6.3σ). $10,574 across 400 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.

HARRISON DIALYSIS LLCHARRISONProvider total: $346.8K

criticalCost OutlierScore: 6.2

Cost-per-claim above average for 96375

HIGHLANDS ONCOLOGY GROUP PA (1346211323) bills $168.21/claim for 96375 (Tx/pro/dx inj new drug addon) vs avg $15.89 (+6.2σ). $22,540 across 134 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.

HIGHLANDS ONCOLOGY GROUP PASPRINGDALEProvider total: $5.7M

criticalCost OutlierScore: 6.2

Cost-per-claim above average for 80061 (Lipid Panel (Cholesterol, HDL, LDL, Triglycerides))

ARKANSAS HEART HOSPITAL, LLC (1790775229) bills $48.23/claim for 80061 (Lipid panel) vs avg $8.92 (+6.2σ). $95,742 across 1,985 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.

ARKANSAS HEART HOSPITAL, LLCLITTLE ROCKProvider total: $1.7M

criticalCost OutlierScore: 6.0

Cost-per-claim above average for T1015 (Clinic Service)

THE SUNSHINE SCHOOL, INC. (1164646899) bills $603.06/claim for T1015 (Clinic service) vs avg $103.18 (+6.0σ). $1,621,632 across 2,689 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 SUNSHINE SCHOOL, INC.SEARCYProvider total: $6.9M

criticalCost OutlierScore: 6.0

Cost-per-claim above average for D0210 (Full Mouth X-rays)

MOBILECARE DENTAL, PLLC (1104369370) bills $161.65/claim for D0210 (Intraoral - complete series) vs avg $75.65 (+6.1σ). $80,665 across 499 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.

MOBILECARE DENTAL, PLLCVAN BURENProvider total: $721.2K

criticalCost OutlierScore: 6.0

Cost-per-claim above average for 87070 (Bacterial Culture (Aerobic))

BAPTIST HEALTH (1043240682) bills $63.28/claim for 87070 (Culture othr specimn aerobic) vs avg $11.87 (+6.0σ). $73,658 across 1,164 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.

BAPTIST HEALTHLITTLE ROCKProvider total: $16.5M

criticalCost OutlierScore: 5.9

Cost-per-claim above average for 82570

CAPES DIALYSIS LLC (1497050595) bills $44.64/claim for 82570 (Assay of urine creatinine) vs avg $5.26 (+5.9σ). $19,821 across 444 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.

CAPES DIALYSIS LLCSEARCYProvider total: $1.5M

criticalCost OutlierScore: 5.8

Cost-per-claim above average for 92340

CHARLES TODD (1275619876) bills $92.80/claim for 92340 (Fit spectacles monofocal) vs avg $44.33 (+5.8σ). $30,994 across 334 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.

CHARLES TODDCONWAYProvider total: $115.4K

criticalCost OutlierScore: 5.7

Cost-per-claim above average for T2020

BOONE COUNTY INDEPENDENT LIVING, INC. (1851458301) bills $229.81/claim for T2020 (Day habil waiver per diem) vs avg $39.24 (+5.7σ). $395,733 across 1,722 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.

BOONE COUNTY INDEPENDENT LIVING, INC.HARRISONProvider total: $3.3M

criticalCost OutlierScore: 5.6

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

SUSAN ZICKLER (1336417997) bills $95.01/claim for 99213 (Office o/p est low 20 min) vs avg $24.10 (+5.6σ). $44,562 across 469 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.

SUSAN ZICKLERHARRISONProvider total: $46.0K

criticalCost OutlierScore: 5.6

Cost-per-claim above average for 71045 (Chest X-ray (Single View))

MOBILE RADIOLOGY SERVICES, INC. (1396745071) bills $24.37/claim for 71045 (X-ray exam chest 1 view) vs avg $7.40 (+5.6σ). $44,526 across 1,827 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.

MOBILE RADIOLOGY SERVICES, INC.JONESBOROProvider total: $64.0K

criticalCost OutlierScore: 5.6

Cost-per-claim above average for 84100

HARRISON DIALYSIS LLC (1659522076) bills $21.45/claim for 84100 (Assay of phosphorus) vs avg $2.83 (+5.6σ). $15,098 across 704 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.

HARRISON DIALYSIS LLCHARRISONProvider total: $346.8K

criticalCost OutlierScore: 5.5

Cost-per-claim above average for Q9967

BAPTIST HEALTH (1902868391) bills $190.57/claim for Q9967 (Locm 300-399mg/ml iodine,1ml) vs avg $12.90 (+5.5σ). $11,434 across 60 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.

BAPTIST HEALTHMALVERNProvider total: $2.7M

criticalCost OutlierScore: 5.4

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

CROSSETT HEALTH FOUNDATION (1578567111) bills $92.53/claim for 99213 (Office o/p est low 20 min) vs avg $24.10 (+5.4σ). $132,967 across 1,437 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.

CROSSETT HEALTH FOUNDATIONCROSSETTProvider total: $869.0K

criticalCost OutlierScore: 5.4

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

PRO-KIDS THERAPY, LLC (1710137500) bills $169.72/claim for 97110 (Therapeutic exercises) vs avg $51.79 (+5.4σ). $193,316 across 1,139 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.

PRO-KIDS THERAPY, LLCLITTLE ROCKProvider total: $1.9M

criticalCost OutlierScore: 5.4

Cost-per-claim above average for H2019 (Therapeutic Behavioral Services (per 15 min))

AUTISM IN MOTION CLINICS, LLC (1255850525) bills $182.99/claim for H2019 (Ther behav svc, per 15 min) vs avg $74.27 (+5.4σ). $344,389 across 1,882 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.

AUTISM IN MOTION CLINICS, LLCBRYANTProvider total: $12.2M

criticalCost OutlierScore: 5.4

Cost-per-claim above average for A0120

YELL COUNTY SPECIAL SERVICES CENTER, INC. (1437283421) bills $462.25/claim for A0120 (Noner transport mini-bus) vs avg $61.54 (+5.4σ). $338,369 across 732 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.

YELL COUNTY SPECIAL SERVICES CENTER, INC.OLAProvider total: $5.5M

criticalCost OutlierScore: 5.4

Cost-per-claim above average for J3490

BIO-MEDICAL APPLICATIONS OF ARKANSAS, INC. (1821100678) bills $434.98/claim for J3490 (Drugs unclassified injection) vs avg $17.35 (+5.4σ). $14,789 across 34 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.

BIO-MEDICAL APPLICATIONS OF ARKANSAS, INC.WEST MEMPHISProvider total: $1.4M

criticalCost OutlierScore: 5.3

Cost-per-claim above average for 96374

BRADLEY COUNTY MEDICAL CENTER (1194741611) bills $234.50/claim for 96374 (Ther/proph/diag inj iv push) vs avg $25.74 (+5.3σ). $80,902 across 345 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.

BRADLEY COUNTY MEDICAL CENTERWARRENProvider total: $2.3M

criticalCost OutlierScore: 5.3

Cost-per-claim above average for 80061 (Lipid Panel (Cholesterol, HDL, LDL, Triglycerides))

ARKANSAS HEART HOSPITAL LLC (1841898293) bills $42.75/claim for 80061 (Lipid panel) vs avg $8.92 (+5.3σ). $16,714 across 391 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.

ARKANSAS HEART HOSPITAL LLCBRYANTProvider total: $566.3K

criticalCost OutlierScore: 5.3

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

SUPERINTENDENT OF HAMBURG HIGH (1164549291) bills $177.89/claim for 97530 (Therapeutic activities) vs avg $54.93 (+5.3σ). $152,985 across 860 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.

SUPERINTENDENT OF HAMBURG HIGHHAMBURGProvider total: $314.8K

criticalCost OutlierScore: 5.3

Cost-per-claim above average for T2020

RAINBOW OF CHALLENGES, INC. (1114031275) bills $216.59/claim for T2020 (Day habil waiver per diem) vs avg $39.24 (+5.3σ). $693,090 across 3,200 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.

RAINBOW OF CHALLENGES, INC.HOPEProvider total: $37.9M

criticalCost OutlierScore: 5.3

Cost-per-claim above average for 83735

DIALYSIS CENTERS OF NORTHWEST ARKANSAS, LLC (1477027795) bills $25.65/claim for 83735 (Assay of magnesium) vs avg $5.10 (+5.3σ). $21,158 across 825 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 CENTERS OF NORTHWEST ARKANSAS, LLCSPRINGDALEProvider total: $421.3K

criticalCost OutlierScore: 5.2

Cost-per-claim above average for 96361

WHITE RIVER HEALTH SYSTEM, INC. (1417913419) bills $146.95/claim for 96361 (Hydrate iv infusion add-on) vs avg $23.90 (+5.2σ). $398,958 across 2,715 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.

WHITE RIVER HEALTH SYSTEM, INC.MOUNTAIN VIEWProvider total: $3.3M

criticalCost OutlierScore: 5.2

Cost-per-claim above average for D1120 (Child Dental Prophylaxis (Teeth Cleaning))

BRIANNA PHILLIPS (1760041248) bills $59.50/claim for D1120 (Prophylaxis - child) vs avg $33.07 (+5.2σ). $10,889 across 183 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.

BRIANNA PHILLIPSFAYETTEVILLEProvider total: $61.5K

criticalCost OutlierScore: 5.1

Cost-per-claim above average for 99393 (Preventive Visit, Established Patient (Ages 5-11))

MENA HOSPITAL COMMISSION (1598322810) bills $133.79/claim for 99393 (Prev visit est age 5-11) vs avg $49.60 (+5.1σ). $163,760 across 1,224 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.

MENA HOSPITAL COMMISSIONMENAProvider total: $864.8K

criticalCost OutlierScore: 5.1

Cost-per-claim above average for T1015 (Clinic Service)

PNC, INC. (1295949238) bills $526.27/claim for T1015 (Clinic service) vs avg $103.18 (+5.1σ). $4,591,671 across 8,725 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.

PNC, INC.PRESCOTTProvider total: $7.4M

criticalCost OutlierScore: 5.1

Cost-per-claim above average for 99391 (Preventive Visit, Established Patient (Infant, <1 year))

VILDAN TAS (1558672048) bills $137.64/claim for 99391 (Per pm reeval est pat infant) vs avg $52.51 (+5.1σ). $11,012 across 80 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.

VILDAN TASLITTLE ROCKProvider total: $59.8K

criticalCost OutlierScore: 5.1

Cost-per-claim above average for 99392 (Preventive Visit, Established Patient (Ages 1-4))

MENA HOSPITAL COMMISSION (1598322810) bills $134.23/claim for 99392 (Prev visit est age 1-4) vs avg $50.39 (+5.1σ). $261,472 across 1,948 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.

MENA HOSPITAL COMMISSIONMENAProvider total: $864.8K

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