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