Arbitrage Events
Real-time monitoring of pricing discrepancies, billing errors, and cost optimization opportunities
Total Financial Impact
$197,850
Active Events
3
Critical Severity
1
Resolved
1
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All confidence levels
critical
high
medium
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active
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Billing Discrepancy
Duplicate Claims
Eligibility Issue
Coding Error
Prior Authorization
Network Issue
Showing 1-5 of 5 eventsPage 1 of 1
MEDIUM
Network Issue
85% Confidence
Site of Service Optimization
Infusions performed in HOPD that could be shifted to home infusion or ambulatory center.
45 Claims
+$125,000
CRITICAL
Duplicate Claims
98% Confidence
Duplicate Specialty Drug Claims
Multiple claims submitted for the same specialty drug administration across medical and pharmacy benefits within 48 hours.
12 Claims
Root Cause Identified
-$42,500
HIGH
Billing Discrepancy
92% Confidence
Dialysis Bundling Leakage
ESRD dialysis services unbundled from global rate at out-of-network facilities.
5 Claims
Root Cause Identified
-$18,750
MEDIUM
Eligibility Issue
100% Confidence
Retroactive Eligibility Termination
Claims paid for members term-ed retroactively > 60 days.
28 Claims
-$8,400
LOW
Coding Error
88% Confidence
Assistant Surgeon Coding Error
Modifier 80/81/82 usage inconsistent with procedure code guidelines.
15 Claims
-$3,200