Payment Cycle Management
Nothing eats into your bottom line like inaccuracy, overpayment, and fraud.
OptumInsight can help ensure claims are processed right the first time — and make remediation easier if they aren’t. Our solutions enable prospective claims analysis and payment, and retrospective investigation and recovery, by detecting and deterring fraudulent, erroneous, and abusive claims — while at the same time improving provider relationships. This broad range of capabilities, expertise, and flexible approach results in a positive feedback loop that drives sustainable improvements and provides a competitive advantage.
With OptumInsight claims management solutions, you may realize results similar to these:
- $300,000 savings per month with the OptumInsight claims editing system — as well as government security standards compliance
- Savings and recoveries of $2.25 per month, per member on third-party liability claims, nearly four times the former recovery rate
- Reduced administrative costs associated with home health programs by about $270,000 per month using prospective payment solutions
- $25 million in potential post-pay recoveries/errors shifted to measurable pre-pay, cost-avoidance savings
- Improved end-to-end claims processing performance
OptumInsight payment cycle management solutions leverage innovative technologies and expertise to provide you with unprecedented control over claims and payments — allowing your organization to move from recovery to avoidance to prevention.
Pre Payment Solutions
OptumInsight pre-payment solutions help you avoid inappropriate medical expense payouts by providing facility and professional claims editing, prospective payment solutions, fraud and abuse detection, injury coverage coordination, out-of-network fee negotiations and prepricing, and member enrollment integrity.
Our software and services help you:
- Prevent payment on erroneous claims
- Discover potentially fraudulent claims
- Successfully manage out-of-network provider relations and payments
- Reduce administrative costs with readily customizable claims editing
Post Payment Solutions
OptumInsight post-payment solutions help you recover overpayments and use the linked analytics to discover the root cause of overpayments, so you can avoid overpaying in the future and prevent unnecessary cost.
Our retrospective services and software help you:
- detect and recover fraud and abuse
- identify and recover subrogation-related claims
- resolve credit balances with onsite and remote resources
- contain costs with specialty audit solutions
- identify, validate, and recover overpayments
Consulting
OptumInsight payment cycle management consultants understand the unique challenges facing payers in today’s highly competitive health care industry and can help you transform and improve the way you do business to stay ahead of the curve.