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Your organization’s data, resources and needs are unique

Optum takes a customized approach to its Submission Services. We combine consultative services and technology to provide you transparency and workflow tools via a self-service portal.

Better outcomes for members, health plans and providers

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Proven experience behind every submission

Your organization’s data, resources and needs are unique. That’s why Optum takes a customized approach to its Submission Services. We combine consultative services and technology to provide you transparency and workflow tools via a self-service portal.

At Optum, the Submission Services we offer are different. We provide consultative support to manage submissions, direct errors and remediation. In regular client sessions, we provide insights to encourage continuous improvement and maximize accuracy of your submissions.

This customizable, scalable solution helps simplify Encounter Data System (EDS) submissions to CMS. It can be tailored to meet your needs and match your data. Optum® Submission Services platform offers:

  • Easy-to-use, single-user interface with dashboard reporting, including legacy metrics, for full data transparency
  • Ability to see data error details such as value assessment of risk-adjustable services with new and unique diagnosis codes
  • Self-service portal enables you to view and track submissions by claim DOS and file
  • Client-driven error correction through portal
     

Deep expertise and proven CMS track record

Our team of experts continually monitors CMS submission guidance for updates. This supports the accuracy and completeness of data that we submit on your behalf. When we identify a change affecting your data, we will notify you and resubmit any data to minimize rejections.

Your organization’s data, resources and needs are unique. That’s why Optum takes a customized approach to its Submission Services. We combine consultative services and technology to provide you transparency and workflow tools via a self-service portal.

It’s what sets us apart from vendors that take a one-size-fits-all approach to intake data, transform it and submit it to the Department of Health and Human Services (HHS).

Optum has a proven history of successful Affordable Care Act (ACA) implementations and extensive health care systems knowledge. This qualifies us to lead clients to successful External Data Gathering Environment (EDGE) server submission implementations.

Our HHS EDGE server submission services provide end-to-end support and transparency. We submit data to the Department of Health and Human Services (HHS) in the specified format and required frequency (minimum of quarterly). We track those submissions and resulting HHS responses.

Optum monitors HHS business rules continually and notifies clients immediately of updates. We help them understand the impact so they can take appropriate action.

Experience to fully manage EDGE submissions

  • Analytics: We detect errors before submission.
  • Accuracy: We submit data to HHS EDGE server with consistent acceptance rate over 99%.
  • Implementation: Client infrastructure can be available within six weeks.
  • Volume: Infrastructure can support millions of claims per year and process as many linked transactions as needed.