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Achieving success in claims editing

Learn best practices around content and rule definition.


 FEMALE VOICEOVER: We understand that medical claim coding, reimbursement, and clinical accuracy is complex. There are millions of government regulations, industry standards, and internal business policies that must be considered during claim processing. Our claims edit system accurately delivers professional and facility edits across Medicare, Medicaid, and commercial claims, all with your existing adjudication process. As claims enter the system, they are evaluated against the latest state, federal, and commercial guidelines. Potential errors are flagged and reported with recommended action. All editing decisions are sourced to minimize appeals, and rule logic is transparent to users, to support provider communication. Edits are developed and maintained by a team of over 100 specialists who research industry trends and changes to update the latest rules across standard, specialty, and custom editing. We also offer application managed services, with experts who act as an extension of your team to expedite the implementation of new rules, improve operations, and increase savings from editing. Our AMS team will also consult on business process, technology, and payment policy review. Health plans using Claims Edit System average $36 to $54 per member per year in savings. And those partnering with our AMS team can see an additional savings of $24 to $42 per member per year. Improve your claims accuracy and increase savings today with Claims Edit System from Optum.

Achieving success in claims editing

Learn how creating a flexible editing program can help to catalyze a health plan's specific strategic business imperatives. Whether it’s enforcing and enhancing certain policies or minimizing overpayments, these best practices can guide you to success.

Add Claims Edit System technology to your payment integrity portfolio today.