Optum is an approved NASPO ValuePoint supplier partner of the MMIS Claims Processing and Management Module to state Medicaid agencies nationwide. Optum Claims Administration Services is a COTS-based, MITA-aligned module delivered as a service (Business Process as a Service, BPaaS).
Core offering: Claims Administration Services Module
- Adjudicate, edit, price and determine reimbursement amounts for health care claims
- Process service authorizations, third-party insurance liability, and calculate member liabilities
- Includes a robust financial management capability for back-end financial functionality of paying claims, data tracking and reporting
Option B: Member and provider call center
Optum Call Center services is a HIPPA-compliant contact center for members and providers. They answer a broad variety of call types and questions on policies and claims for state Medicaid programs. Using automated call distribution and workforce management technologies, our solution includes multiple HIPPA-compliant communication methods along with performance management call-monitoring and more.
Option C: Federal Reporting
Our Federal Reporting Solution has three components:
- Optum Management and Administrative Reporting System (MARS) is a financial reporting and analytical solution. It provides CMS Program Management certification and advanced capabilities to support the management and oversite of Medicaid programs.
- Optum Fraud and Abuse Detection System (FADS) meets the Program Integrity checklist items from the Medicaid Enterprise Certification Toolkit (MECT).
- Operational reporting capabilities within the Optum Claims Administration Services module covers claims administration, utilization management and financial management requirements.