Post Payment Solutions
Our proven recovery solutions give states comprehensive options for identifying and recovering inappropriate payments.
Credit Balance Services
Communicate, resolve and recover
Optum™ Credit Balance Resolution services augment the existing efforts of both Medicaid and its providers to find, resolve, and recover claims overpayments. On-site credit balance auditors use sophisticated technology to help track inventory through each stage of the resolution process. We'll help you recover more, in less time.
Fraud Abuse and Detection System
Prevent, detect and recover
Optum™ Fraud and Abuse Detection System (IFADS), is a solution suite comprised of tools designed to help manage fraud and abuse investigations from detection through collection. When all components are installed, IFADS allows jurisdictions to meet 100 percent of the CMS Program Integrity Business Area Checklist requirements.
Overpayment Recoveries uses three methods to efficiently and effectively recover Medicaid overpayments from providers: traditional collections, direct assistance from an on-site recovery specialists and direct connections from web portal technology. This three-tiered program provides 100 percent resolution on accounts receivable.
Retrospective Fraud and Abuse Recovery
Effective detection and recovery
Detecting health care fraud isn’t easy. Unfortunately, after-the-fact collections are rarely paid in full due to resource limitations and the volume of data involved. Optum Retrospective Review and Recovery services includes sophisticated fraud detection technology and predictive analytics examine historical claims to identify patterns and trends that signify fraudulent or abusive activity for review by government staff. Optum experts can help you more effectively detect and recover claims overpayments resulting from fraud and abuse.
Systems Analysis and Vulnerability Assessments
Improve the operation and efficiency of Medicaid programs
Optum™ provides deep public sector expertise and a full range of program integrity solutions to support government efforts in identifying appropriate payment upfront, as well as retrospectively recovering inaccurate, inappropriate, or fraudulent Medicaid payments.