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Presenter: We understand the dynamic and complicated
nature of healthcare can lead to a high potential
for fraud, waste, abuse and errors.
There are many factors
that magnify this inherent complexity,
including ever changing rules
by governing bodies such as CMS,
confusing and ambiguous payment policies
and provider contracts over 85,000 diagnosis codes
and multiple forms of reimbursement.
In fact, nearly $1 trillion are wasted every year.
Our claims validation solution
combines pre and post-payment technology
and experts services to maximize savings,
reduce repeat errors and minimize provider abrasion.
Our pre-payment validation
uses predictive scoring models
that leverage advanced machine learning
to systematically analyze all claim types for billing errors
and suggests a hold, pend or deny action
all of this occurs after claims have been adjudicated,
but prior to actual payment.
Our post-payment validation process
aligns with pre-payment validation process
to conduct look back reviews
of claims paid prior
to instituting a pre-payment validation process.
Additionally, post-payment validation continues
to identify claims with errors
that are not appropriate for a pre-pay audit.
Once claims are selected for review,
certified coding professionals
conduct reviews onsite or remotely
to enhance relationships with providers
while casting the widest net to catch errors
along the payment lifecycle
across all reimbursement methodologies,
we ensure minimal provider abrasion
and operational burden by targeting less than point 5%
of all submitted claims.
Applying pre-pay and post-payment validation and audits
is more effective,
lessens provider abrasion
and optimizes results for you.
Optum's advance machine Learning risk scores 100%
of your claims, every single day,
our true positive rates can approach 70% or more
and less than 2% of appeals are overturned.
Our integrated pre and post-payment solution
can save two to 5% of your medical expenses
which could generate hundreds of millions
in medical expense savings each year.
Bottom line, you can audit less and save more with optum.
optimist focused on empowering accurate
effortless payments for all by providing solutions
at every touchpoint in the billing and claim lifecycle.
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