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Comprehensive Denial Prevention

Prevent health care claim denials and reduce administrative waste.


Denial prevention is the new denial management in health care

Did you know 86% of claim denials are preventable and result in needless rework and administrative cost for health plans and providers?*

Optum® Comprehensive Denial Prevention is a shift-left provider education and error prevention program that will change how you think about payment accuracy and denial management. Our tools help both health plans and providers by:

  • Preventing claim denials
  • Enabling mutual transparency
  • Providing greater efficiency
  • Reducing administrative burden
  • Increasing payment accuracy
  • Improving the patient experience 

Get near real-time messaging for better health care claim denial management

With Comprehensive Denial Prevention, health plans and providers exchange common information at the point of coding and billing.

We do this by creating connections between health plan claim editors and provider practice management systems. This enables billing entries or claims to be evaluated against editing rule sets before submission or adjudication.

With our tools, providers are alerted to actionable errors in near-real time. This allows them to take corrective action within their existing workflows and submit accurate, complete claims the first time.


Proactively engage providers to prevent claim denials

Educating providers is critical to improving claim accuracy. Our managed services team directly engages providers to help improve:

  • Messaging adoption
  • Claim correction rates
  • Provider satisfaction

Find out how to add Comprehensive Denial Prevention to your payment integrity portfolio today

*Gavidia, Matthew. Medical Claim Denial Rates Rising, Highest in Initial COVID-19 Hotspots. American Journal of Managed Care. January 21, 2021.