Case Study: Identifying Millions in Unbilled Trauma Charges

A large urban Level I trauma center suspected ongoing revenue leakage related to trauma activations, but lacked a systematic way to identify missed or incorrectly billed cases.

As an early implementation partner, the hospital used NQS Activate360™ to analyze trauma and claims data, identifying millions in clinically supported, trauma-related charges as unbilled and recovering significant revenue after rebilling.

For trauma leaders and hospital revenue teams, this case study shows how much can stay hidden when clinical and billing data are not connected, and how validated trauma registry data can support more accurate billing and stronger revenue integrity.

The challenge

The hospital faced a familiar set of issues:

• trauma activation criteria were documented clinically but not consistently reflected in billing
• limited visibility into discrepancies between trauma registry data and submitted claims
• manual, retrospective audits that were time-consuming and incomplete
• missed opportunities to review cases before timely filing windows closed

Leadership believed legitimate trauma activation revenue was being missed, but did not have a scalable way to prove where the gaps were.

The solution: NQS Activate360™

The hospital deployed NQS Activate360™, a registry-powered revenue integrity solution designed for trauma programs.

Activate360™ brought together:

• trauma registry data
• 837 claim files
• 835 remittance files

Using these data sources, Activate360™ helps hospitals:

• identify cases where trauma activation criteria were met clinically but not billed
• flag discrepancies between clinical documentation and billing data
• review case-level opportunities with supporting detail
• prioritize cases for follow-up by the appropriate hospital teams

The results

Using Activate360™ over a 12 month period, the trauma center uncovered:

• millions in trauma activation-related charges that were clinically supported but not billed
• a prioritized subset of high-confidence rebill candidates
• automated notifications sent directly to billing teams with supporting documentation

After rebilling the identified cases and processing updated claims:

• significant incremental revenue was successfully recovered
• recovered revenue required no new volume, staffing, or contracts
• the hospital established a repeatable, auditable process for ongoing recovery

Why this matters

Traditional audits are often manual, slow, and incomplete. Registry data, claims, and remittance data often live in separate systems, making discrepancies hard to find and harder to act on.

Activate360™ gives trauma and revenue leadership a more direct way to connect those data sources, flag potential issues, and support a more repeatable review process.

That helps teams move from suspicion to identified cases, supported documentation, and clearer next steps.

Conclusion

This case study is ultimately about visibility.

In 12 months, a large urban Level I trauma center identified millions in clinically supported trauma activation-related charges as unbilled using NQS Activate360™. That gave the hospital a stronger foundation for case review and trauma revenue integrity work—without overpromising outcomes beyond the source data.

Learn more about Activate360™ or schedule a demo of Activate360™.