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Diagnosis-related group (DRG) outlier

For a Blues plan, Optum clinical staff found dosages for the identified medication far exceeding the recommended maintenance dose for a neonate. This saved our client nearly $600,000, more than one-fourth 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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DRG outlier identified, resulting in $200,578 savings.
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Comprehensive payment integrity savings

Inform and improve your entire claims management lifecycle.

Realize cost savings with our payment integrity solutions