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Healthcare claim payments
are complex,

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and with ever changing rules
by governing bodies,

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such as the Centers for Medicare
and Medicaid Services,

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ambiguous payment policies
and provider contracts,

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over 85,000 diagnosis codes,

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and multiple forms of reimbursement
adding to the complexity,

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there's a high potential for fraud,

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waste, abuse, and error.

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Optum Claim Review combines
advanced claim selection analytics

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with expert review services

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to maximize savings,
reduce repeat errors,

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and minimize provider abrasion.

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Claim Review systematically analyzes
and scores all claim types,

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with best in class accuracy.

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Using predictive scoring models,

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we flag claims with a high likelihood
of billing errors

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for manual review.

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Targeted claims are reviewed
by certified coders and clinicians,

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and depending on the claim type,

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reviews often include comparing
the claim against a medical record.

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Claim review can be deployed
both pre and post payment,

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ensuring you catch errors

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across all reimbursement
methodologies

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and at every step
in the payment life cycle.

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Learn how we can help you increase
your medical expense savings

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with Optum Claim Review.