Simplify systems to reduce costs and increase accuracy
We proactively drive payment integrity, and improve provider relationships and member experience. Our solutions transform end-to-end claims processing performance by simplifying the payment system, improving accuracy and reducing costs.
With this holistic approach, we can help:
- Identify and recover inappropriate claim payments and overpayments
- Simplify and reduce the administrative cost of the payment cycle
- Avoid and prevent inappropriate claim payments and overpayments
- Drive out unnecessary and inappropriate medical costs
- Outsource payment cycle services, enabling plans to focus on core competencies
Our comprehensive software and services include pre-payment, payment and post-payment solutions.
Assessment and optimization
We can help you implement a well-coordinated enterprise payment integrity program that will both identify pre- and post-payment claims processing problems. Such a system will also yield actionable intelligence for systemic improvements that will improve accuracy, lower costs and improve provider satisfaction.
Payment integrity is a strategic imperative.
The strategic payment integrity approach:
- Cuts operating and medical expenses.
- Mitigates future risk.
- Retains member and provider loyalty.
Power claims editing technology
Optum™ Claims Edit System provides an extensive set of core rules that utilize historical data to maximize your auditing capabilities for commercial, Medicaid and Medicare claims. More than an unbundling and editing tool, this system features flexible editing functions and complete customization capabilities, so you can create unique auditing logic to implement your proprietary business rules.
Prospective Payment Solutions
Fraud, waste and abuse services
Subrogation and injury coverage coordination
Maximize savings and recoveries with accurate identification and effective prevention strategies.
Subrogation Services and Injury Coverage Coordination Services from Optum™ help identify, prevent, investigate and recover accident-related medical and disability claims expenses to determine the responsible party for bearing claim payment liability.
Optum recovery services offer the only multifaceted approach to address payers’ unique collection needs. Our long-standing relationships with providers and health plans allow us to resolve inventory quickly, going beyond expediting recovery to focus on complete claims resolution. By leveraging our expertise and technology, we help plans reduce administrative and medical costs, analyze long-standing issues and recommend process improvements.