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Get your payment integrity house in order

Is your PI strategy maximizing savings? How can you be sure?

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Female Speaker: Embracing the future, comprehensive payment integrity. Payers need to change business as usual and rise to the challenge of reducing medical and administrative costs. They need to adopt the comprehensive PI strategy so they can improve bottom-line savings, reduce provider operation and focus on member satisfaction.

Some payers may have insight into their claim over-payments, but most don't really know how many inappropriate claim payments and over-payments they are making or recapturing. The scope is compelling. Anywhere from 7% to 15% of claims are discovered to have been paid inaccurately, as a result of commonplace mistakes, fraud, and more causes.

Adopting comprehensive payment integrity could save $362,000,000,000 annually in medical costs. Payers, typically lose 20 to 30 cents for every dollar recovered, by trying to chase around erroneous payments after they have been made. Trying to recover disbursements made in error to providers can damage relationships. The problem is, that responsibility for payment integrity is currently siloed in several departments.

As a result, efforts can overlap and conflict when information isn't shared, creating a lack of real insight into actual performance. How can payers not just survive but move ahead of the competition and begin to thrive? Payer executives need to align internally on payment integrity to analyze and share data to yield greater better benefits and maximize savings opportunities.

In short, payers must elevate payment integrity into a core strategic function by creating a single payment integrity office that breaks down silos. The centralized payment integrity office must harness data, analytics, predictive modeling, and innovations, to target and establish actionable progress metrics. This will strengthen pre-adjudication and prepayment cost avoidance methods.

Today's dynamic and competitive marketplace makes comprehensive payment integrity essential. Choose trusted, proven payment integrity partners to keep moving forward. It's time to assess your payment integrity practices by visiting Optum at www.optum.com/piassessment.

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A PI strategy that paves the way to success

Is a centralized payment integrity strategy vital to payers? We say yes. This animated infographic from Optum and Health Data Management reveals what’s needed for a robust PI model. Maximize medical and administrative savings and stay on top in this age of change.

Video transcript: Embracing the future: Comprehensive Payment Integrity

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Video transcript:

Payers need to change business as usual and rise to the challenge of reducing medical and administrative costs.

They need to adopt a comprehensive PI strategy so they can improve bottom-line savings, reduce provider abrasion and focus on member satisfaction.

Some payers may have insight into their claim overpayments, but most don’t really know how many inappropriate claim payments and overpayments they are making, or recapturing, but the scope is compelling:

Anywhere from 7-15% of claims are discovered to have been paid inaccurately as a result of commonplace mistakes, fraud, and more causes.

Adopting Comprehensive Payment Integrity could save $362B annually in medical costs.

Payers typically lose 20 to 30 cents for every dollar recovered by trying to chase erroneous payments after they have been made.

Trying to recover disbursements made in error to providers can damage relationships.

The problem is that responsibility for payment integrity is currently siloed in several departments.

As a result, efforts can overlap and conflict when information isn’t shared, creating a lack of real insight into actual performance.

So how can payers not just survive but move ahead of competition and begin to thrive?

Payer executives need to align internally on payment integrity to analyze and share data to yield greater benefits and maximize savings opportunities.

In short, payers must elevate payment integrity into a core strategic function by creating a single Payment Integrity office that breaks down silos.

The centralized payment integrity office must harness data, analytics, predictive modeling and innovations to target and establish actionable progress metrics.

This will strengthen pre-adjudication and pre-payment cost avoidance methods.

Today’s dynamic and competitive marketplace makes comprehensive Payment Integrity essential.

Choose trusted, proven Payment Integrity partners to keep moving forward. It’s time to assess your payment integrity practices by visiting Optum at optum.com/PIAssessment