Optum claims processing master agreement
We deliver claims administration through NASPO ValuePoint.
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.