Analysis of self-funded claims data consistently reveals three areas where overpayments occur with notable frequency: 1. Coding Compliance Gaps Hospital billing departments optimize procedure coding within regulatory boundaries to maximize legitimate reimbursement. However, this optimization sometimes results in coding selections that may not fully align with the actual services provided. DRG up-coding and NCCI bundling discrepancies frequently pass through standard review processes, resulting in overpayments that can range from $10,000 to $30,000 per incident for complex inpatient procedures. These aren't necessarily intentional errors—they often reflect the complexity of medical coding and the challenges of translating clinical care into billing codes. 2. Contract Rate Validation Challenges Negotiated provider contracts establish specific reimbursement rates, but systematic verification against actual claims remains uncommon in many organizations. Without automated contract rate validation, there's an inherent reliance on provider billing accuracy that can result in payments above contracted amounts. This represents a significant opportunity area, as contract rate discrepancies tend to be consistent and ongoing rather than one-time occurrences. 3. Underutilized Program Benefits Section 501(r) requires non-profit hospitals to provide charity care based on patient financial circumstances, but proactive eligibility screening rarely occurs as part of standard claims processing. Employees who qualify for charity care reductions based on household income and family size represent potential savings that often go unidentified. Similarly, other program benefits and discounts may be available but not systematically applied without dedicated screening processes.