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.

Estate Recovery

Resolve and recover, respectfully

At Optum™, our Estate Recovery services are customized to meet each state’s specific estate recovery statues. Optum provides subject matter expertise and comprehensive analysis of a variety of data sources to assist states in recovering of expenses.

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

Surefire resolution

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.

Subrogation

Secure reimbursement

Optum™ Subrogation Services can successfully identify, investigate and recover accident-related medical and disability claims expenses for your organization.

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.