Hospital
Prisma Health-Upstate
Prisma Health-Upstate was paid $206K by Medicaid between Mar 2018 and Dec 2024, across 23 billing codes. Its largest line is 99213, doctor's office visit, returning patient (routine) — 34% of everything it billed.
33Billing provider infoPRISMA HEALTH-UPSTATE
GREENVILLE, SC 29605
GREENVILLE, SC 29605
33aNPI1942756051assigned 08/29/2016
33bProvider typeGeneral Acute Care Hospital
28Total paid$206K
24GClaims4,540
24DCodes billed23
24AFirst – last monthMar 2018 – Dec 2024
Compared with peers
Next to other General Acute Care Hospital providers in South Carolina
Rank by total paid#80 of 115
Median peer was paid$2.47M
This provider vs. median0.1×
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.
Entity ProliferationAuthorized official MILLER, POLLY controls 20+ related entities in our dataset. Read more
Box 24A · Dates of service
Paid by month
Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider
By year, as a table
| Year | Claims | Paid | |
|---|---|---|---|
| 2018 | 143 | $9K | |
| 2019 | 103 | $9K | |
| 2020 | 71 | $6K | |
| 2021 | 171 | $13K | |
| 2022 | 188 | $12K | |
| 2023 | 221 | $13K | |
| 2024incomplete | 3,643 | $144K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 34% | 1,288 | 1,209 | $71K |
| 36415 | Collection of venous blood by venipuncture | 30% | 620 | 552 | $62K |
| 99214 | Doctor's office visit, returning patient (more involved)Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity | 13% | 752 | 656 | $27K |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | 11% | 249 | 238 | $22K |
| 80307 | Drug test(s), presumptive, any number of drug classes; immunoassay | 6.2% | 83 | 78 | $13K |
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient, minimal severity | 5.0% | 142 | 119 | $10K |
| 83036 | Hemoglobin; glycosylated (A1C) | <1% | 211 | 201 | $954.82 |
| 83540 | 0% | 12 | 12 | $0.00 | |
| 84466 | 0% | 12 | 12 | $0.00 | |
| 80061 | Lipid panel | 0% | 104 | 98 | $0.00 |
| 82570 | 0% | 24 | 24 | $0.00 | |
| 90662 | 0% | 35 | 35 | $0.00 |
11 more codes
| 80048 | Basic metabolic panel (calcium, ionized) | 0% | 187 | $0.00 |
| G0480 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed | 0% | 76 | $0.00 |
| 85025 | Blood count; complete (CBC), automated, and automated differential WBC count | 0% | 156 | $0.00 |
| G0008 | Administration of influenza virus vaccine | 0% | 62 | $0.00 |
| 84443 | Thyroid stimulating hormone (TSH) | 0% | 105 | $0.00 |
| 83735 | 0% | 14 | $0.00 | |
| 80053 | Comprehensive metabolic panel | 0% | 160 | $0.00 |
| 82306 | Vitamin D; 25 hydroxy, includes fraction(s), if performed | 0% | 68 | $0.00 |
| 90656 | 0% | 79 | $0.00 | |
| 90673 | 0% | 16 | $0.00 | |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | 0% | 85 | $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.
From NPPES
Who's on the registration
Authorized officialMILLER, POLLY (VP PAYOR STRATEGIES & ALIGNMENT)
| 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.