Prisma Health-Upstate
Prisma Health-Upstate was paid $194K by Medicaid between Jan 2018 and Jun 2023, across 13 billing codes. Its largest line is 36415, Collection of venous blood by venipuncture — 87% of everything it billed.
BOILING SPRINGS, SC 29316
Next to other General Acute Care Hospital providers in South Carolina
Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.
Auditor's notes
Automated statistical signals. Not evidence of fraud — how these are computed.
Paid by month
By year, as a table
| Year | Claims | Paid | |
|---|---|---|---|
| 2018 | 4,231 | $77K | |
| 2019 | 4,983 | $89K | |
| 2020 | 1,859 | $25K | |
| 2021 | 47 | $3K | |
| 2022 | 15 | $480.88 | |
| 2023 | 21 | $487.07 |
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 36415 | Collection of venous blood by venipuncture | 87% | 1,983 | 1,349 | $170K |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | 6.0% | 1,452 | 1,059 | $12K |
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient, minimal severity | 2.9% | 526 | 396 | $6K |
| 96372 | Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular | 2.0% | 66 | 50 | $4K |
| 80048 | Basic metabolic panel (calcium, ionized) | 1.6% | 1,736 | 1,176 | $3K |
| 80076 | <1% | 1,527 | 1,125 | $223.42 | |
| 83540 | 0% | 408 | 366 | $0.00 | |
| 84466 | 0% | 408 | 366 | $0.00 | |
| 85025 | Blood count; complete (CBC), automated, and automated differential WBC count | 0% | 1,879 | 1,299 | $0.00 |
| 83615 | 0% | 748 | 604 | $0.00 | |
| 82728 | 0% | 386 | 347 | $0.00 | |
| 80053 | Comprehensive metabolic panel | 0% | 22 | 21 | $0.00 |
1 more codes
| 82378 | 0% | 15 | $0.00 |
Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.
Who's on the registration
| Provider | Location | Paid |
|---|---|---|
| Prisma Health-Midlands | Columbia, SC | $74.58M |
| Prisma Health-Midlands | Columbia, SC | $68.26M |
| Prisma Health-Upstate | Greenville, SC | $25.04M |
| Prisma Health-Upstate | Greenville, SC | $21.98M |
| Prisma Health-Upstate | Greenville, SC | $19.69M |
| Prisma Health-Upstate | Seneca, SC | $15.64M |
| Prisma Health-Midlands | Columbia, SC | $11.77M |
| Prisma Health-Upstate | Greenville, SC | $10.74M |
| Greenville Health Corporation | Greenville, SC | $8.90M |
| Prisma Health-Upstate | Greenville, SC | $8.32M |
| Prisma Health-Upstate | Greenville, SC | $7.45M |
| Prisma Health University Medical Group | Greenville, SC | $7.44M |
| Prisma Health-Midlands | Coulmbia, SC | $7.43M |
| Prisma Health-Midlands | Columbia, SC | $6.88M |
| Prisma Health Tuomey | Sumter, SC | $6.84M |
| Prisma Health-Midlands | Columbia, SC | $6.77M |
| Prisma Health-Upstate | Greenville, SC | $6.37M |
| Prisma Health-Upstate | Greenville, SC | $5.00M |
| Prisma Health-Upstate | Greenville, SC | $4.65M |
| Prisma Health-Midlands | Columbia, SC | $4.63M |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.