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Emergency Department Claim Analyzer

Help control rising emergency outpatient facility costs with automated, consistent and defensible E/M coding evaluation.

Optum Emergency Department Claims Analyzer - Facility

Determine appropriate ED visit billing levels

Emergency Department Claim (EDC) Analyzer — Facility helps health plans determine fair and consistent levels of facility reimbursement for outpatient emergency department (ED) services. We apply standard cost factors with extended cost factors and patient complexity costs to determine the appropriate visit level.

Consistent and defensible application of CMS guidelines

With no national standard methodology for applying ED visit-level coding, inaccurate billing can occur. EDC Analyzer — Facility was developed around 11 general guidelines for coding outpatient facility levels published by the Centers for Medicare & Medicaid Services (CMS). With a uniform and consistent review of submitted ED visit-level codes, EDC Analyzer — Facility can help deliver an accurate visit-level calculation.


Reduce medical spend through accurate claim payment

After recommending the appropriate visit level, EDC Analyzer — Facility can automatically reprice claims to help ensure appropriate facility reimbursement for ED services rendered, saving health plans an estimated $3-$9 per member per year (PMPY).

Add EDC Analyzer to your payment integrity portfolio today