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Diagnosis-related group (DRG) outlier

For a Blues plan, Optum clinical staff found antifungal agents billed at 10 times the recommended dosage. This saved our client more than $200,000, nearly 85% of the billed charges.

Itemized Bill Review

Our targeted clinical and financial review leverages Centers for Medicare and Medicaid Services (CMS) and clean-claim evaluation to review inpatient facility claims. We work in concert with our clients’ provider relations team, which minimizes provider abrasion.

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Related resources

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Case study 2: High-dollar claim savings

DRG outlier identified, resulting in $600,000 savings.
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Perspectives on health plan trends

Together, we are driving toward the same things for our health care system — better quality, lower cost, and higher consumer and provider satisfaction.
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Comprehensive payment integrity savings

Inform and improve your entire claims management lifecycle.

Realize cost savings with our payment integrity solutions