Payment Integrity

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.



Pre-Payment Solutions

Avoid costly errors

Our pre-payment solutions help avoid inappropriate medical expense payouts. We do this by providing facility and professional claims editing, prospective payment solutions, fraud and abuse detection, injury coverage coordination, enrollment integrity and electronic data interchange (EDI) solutions.

Payment Solutions

Simplified, user-friendly payment solutions

Electronic Funds Transfer and Electronic Remittance Advice
The Electronic Funds Transfer and Electronic Remittance Advice (EFT/ERA) Solution from Optum™ is a fully integrated claims settlement solution that brings electronic data and banking functions together, simplifying a payer’s workflow, lowering costs, and improving provider relations at the same time.

Post-Payment Solutions

Identify, validate and recover inappropriate payments

Our post-payment solutions help health plans recover overpayments and use the linked analytics to discover the root cause of overpayments. This means your organization can avoid overpaying in the future and prevent unnecessary cost.