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Claims Edit System

Achieve clean claims and maximize medical spend savings with our flexible, real-time claim editing software.

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An ever-evolving, complex claim payment landscape

Health plans are facing increasing pressure to pay claims accurately while trying to manage rising medical costs. But they face many challenges and complexities in today’s environment, including:

  • Rapidly evolving loopholes that cause claim coding inconsistencies or excess payment
  • Changing regulatory and compliance Medicare and Medicaid guidelines that make system edits difficult to interpret, make and maintain
  • Legacy systems requiring increased investment to ensure accuracy
  • Provider abrasion due to complex contracts
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Solve your claim editing challenges

Our claim editing software helps solve editing challenges of all sizes. Through fully automated technology and broad, robust content, Optum® Claims Edit System can improve claim accuracy and increase medical spend savings.

Increase medical spend savings with Claims Edit System

Learn how our comprehensive claim editing solution helps health plans save $36 to $54 PMPY* (per member, per year) on average.

Improve claim accuracy

Our modern, scalable software is fully automated, reducing the administrative burden for your team.

Keep up with regulatory and policy changes

Our expansive set of industry rules and regulations helps catch errors, omissions and questionable coding.

Get dedicated support when you need it

Our Application Managed Services team is here to support you in achieving seamless implementation and smooth day-to-day operations.

Address emerging areas of spend

Our library of specialty content suites helps you address trending areas of spend, including emergency department and specialty medication.

Maximize the value of your Claims Edit System

Increase ROI by shifting your edits further left and adding specialty content and analytics to address trending areas of spend.

Comprehensive Denial Prevention

Help prevent claim denials by shifting your edits pre-adjudication or submission.

Emergency Department Claim Analyzer

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

Specialty Rx Analytic Suite

Control rising specialty medication spend and benefit management.

Application Managed Services

Our dedicated AMS team can provide ongoing support to help you operate, maintain and maximize the value of your software.

Achieve claim accuracy and maximize medical spend savings with Claims Edit System

*First-pass savings based on content across various lines of business. Potential savings shown is not a guarantee of actual savings.