Is TRI-COUNTY MENTAL HEALTH SERVICES flagged for Medicaid fraud?

TRI-COUNTY MENTAL HEALTH SERVICES (NPI: 1215979158) has not been flagged by our statistical fraud detection tests. Their billing patterns fall within normal ranges for their specialty.

How much does TRI-COUNTY MENTAL HEALTH SERVICES bill Medicaid?

TRI-COUNTY MENTAL HEALTH SERVICES received $0.0B in total Medicaid payments from 2018-2024, based on HHS billing records. They are classified as a Counselor, Mental Health provider. Located in LEWISTON, ME.

What is NPI 1215979158?

NPI 1215979158 is the National Provider Identifier for TRI-COUNTY MENTAL HEALTH SERVICES. They are a Counselor, Mental Health provider based in LEWISTON, ME. This NPI is registered with the CMS NPI Registry.

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TRI-COUNTY MENTAL HEALTH SERVICES

Counselor, Mental Health·LEWISTON, ME·NPI: 1215979158Share

Compared to Counselor, Mental Health Peers

Total spending distribution among 27 providers in this specialty

P25MedianP75P90

This provider's total spending of $40.0M is at the 75th percentile among 27 Counselor, Mental Health providers.

Active Billing Period:2018-01→2024-03(75 months)

Billing appears to have stoppedLast active: 2024-03

Total Paid

$40.0M

$39,997,088

Total Claims

237K

Beneficiaries

43K

5.5 claims/patient

Avg Cost/Claim

$169

Monthly Spending Trend

Yearly Spending

2018

$7.3M

-4%

2019

$7.0M

-8%

2020

$6.5M

-2%

2021

$6.3M

-9%

2022

$5.8M

-2%

2023

$5.7M

-75%

2024

$1.4M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 20 distinct procedure codes. The top code (T1020 (Personal care services, per diem)) accounts for 42% of total spending.

ProcedureTotalYour Cost/ClaimNational Medianvs MedianPercentile

T1020Personal care services, per diemSee all providers →

$17.0M

7,504 claims

$2,264.66

$296.27

7.6×

Top 5%

T1020Top 5%

Personal care services, per diem

$17.0M

7,504 claims · 42.5%

Your Cost: $2,264.66/claim|Median: $296.27

7.6× median

H0040Assertive community treatment, face-to-face, per 15 minutesSee all providers →

$7.0M

100K claims

$70.69

$266.41

0.3×

Normal range

H0040Normal range

Assertive community treatment, face-to-face, per 15 minutes

$7.0M

100K claims · 17.6%

Your Cost: $70.69/claim|Median: $266.41

0.3× median

T2021Day habilitation, waiver; per 15 minSee all providers →

$5.2M

48K claims

$108.53

$150.51

0.7×

Normal range

T2021Normal range

Day habilitation, waiver; per 15 min

$5.2M

48K claims · 12.9%

Your Cost: $108.53/claim|Median: $150.51

0.7× median

H0004Behavioral health counseling & therapy, per 15 minSee all providers →

$4.6M

61K claims

$75.69

$74.63

1.0×

Normal range

H0004Normal range

Behavioral health counseling & therapy, per 15 min

$4.6M

61K claims · 11.6%

Your Cost: $75.69/claim|Median: $74.63

1.0× median

H0019Behavioral health; residential, per diemSee all providers →

$3.8M

7,489 claims

$501.34

$357.16

1.4×

Normal range

H0019Normal range

Behavioral health; residential, per diem

$3.8M

7,489 claims · 9.4%

Your Cost: $501.34/claim|Median: $357.16

1.4× median

H2033Multisystemic therapy for juveniles, per 15 minutesSee all providers →

$1.1M

2,299 claims

$469.15

$227.82

2.1×

Top 25%

H2033Top 25%

Multisystemic therapy for juveniles, per 15 minutes

$1.1M

2,299 claims · 2.7%

Your Cost: $469.15/claim|Median: $227.82

2.1× median

H2010Comprehensive medication services, per 15 minSee all providers →

$665K

4,244 claims

$156.59

$62.69

2.5×

Normal range

H2010Normal range

Comprehensive medication services, per 15 min

$665K

4,244 claims · 1.7%

Your Cost: $156.59/claim|Median: $62.69

2.5× median

H2019Therapeutic behavioral services, per 15 minSee all providers →

$159K

1,903 claims

$83.69

$84.12

1.0×

Normal range

H2019Normal range

Therapeutic behavioral services, per 15 min

$159K

1,903 claims · 0.4%

Your Cost: $83.69/claim|Median: $84.12

1.0× median

H2011Crisis intervention service, per 15 minutesSee all providers →

$93K

621 claims

$149.43

$215.80

0.7×

Normal range

H2011Normal range

Crisis intervention service, per 15 minutes

$93K

621 claims · 0.2%

Your Cost: $149.43/claim|Median: $215.80

0.7× median

H0018Behavioral health; short-term residential, per diemSee all providers →

$90K

192 claims

$466.85

$467.51

1.0×

Normal range

H0018Normal range

Behavioral health; short-term residential, per diem

$90K

192 claims · 0.2%

Your Cost: $466.85/claim|Median: $467.51

1.0× median

H2018Psychosocial rehabilitation services, per diemSee all providers →

$80K

1,082 claims

$74.07

$392.63

0.2×

Normal range

H2018Normal range

Psychosocial rehabilitation services, per diem

$80K

1,082 claims · 0.2%

Your Cost: $74.07/claim|Median: $392.63

0.2× median

99408 See all providers →

$46K

201 claims

$228.13

$9.32

24.5×

Top 5%

99408Top 5%

$46K

201 claims · 0.1%

Your Cost: $228.13/claim|Median: $9.32

24.5× median

H0047Alcohol and/or drug abuse, not otherwise specifiedSee all providers →

$45K

203 claims

$221.79

$81.37

2.7×

Normal range

H0047Normal range

Alcohol and/or drug abuse, not otherwise specified

$45K

203 claims · 0.1%

Your Cost: $221.79/claim|Median: $81.37

2.7× median

T2022Case management, per monthSee all providers →

$42K

129 claims

$328.89

$202.77

1.6×

Top 25%

T2022Top 25%

Case management, per month

$42K

129 claims · 0.1%

Your Cost: $328.89/claim|Median: $202.77

1.6× median

G9007 See all providers →

$26K

397 claims

$66.64

$43.44

1.5×

Normal range

G9007Normal range

$26K

397 claims · 0.1%

Your Cost: $66.64/claim|Median: $43.44

1.5× median

H2000Comprehensive multidisciplinary evaluationSee all providers →

$22K

282 claims

$77.76

$114.71

0.7×

Normal range

H2000Normal range

Comprehensive multidisciplinary evaluation

$22K

282 claims · 0.1%

Your Cost: $77.76/claim|Median: $114.71

0.7× median

90837Psychotherapy, 60 minutesSee all providers →

$14K

728 claims

$19.82

$85.66

0.2×

Normal range

90837Normal range

Psychotherapy, 60 minutes

$14K

728 claims · 0.0%

Your Cost: $19.82/claim|Median: $85.66

0.2× median

T2017Habilitation, residential, waiver; 15 minSee all providers →

$12K

118 claims

$105.11

$137.32

0.8×

Normal range

T2017Normal range

Habilitation, residential, waiver; 15 min

$12K

118 claims · 0.0%

Your Cost: $105.11/claim|Median: $137.32

0.8× median

99214Office/outpatient visit, est. patient, mod-high complexitySee all providers →

$12K

635 claims

$18.61

$53.41

0.3×

Normal range

99214Normal range

Office/outpatient visit, est. patient, mod-high complexity

$12K

635 claims · 0.0%

Your Cost: $18.61/claim|Median: $53.41

0.3× median

Q3014Telehealth originating site facility feeSee all providers →

$2K

318 claims

$6.26

$15.37

0.4×

Normal range

Q3014Normal range

Telehealth originating site facility fee

$2K

318 claims · 0.0%

Your Cost: $6.26/claim|Median: $15.37

0.4× median

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