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.

With a dedicated staff of more than 750 highly trained on-site account managers and quality specialists, Optum is securely positioned as an industry leader in delivering an unparalleled provider network and service infrastructure to help you recover claims. Only Optum™ has a daily on-site presence with dedicated, on-site account managers in all 50 states.

Our Credit Balance Resolution team of experts helps:

  • Research and resolve credit balance accounts
  • Recover overpayments and help prevent recurring errors
  • Provide actionable reporting and benchmarking health plan performance

Optum Credit Balance Resolution services feature:

Experts on-site at the providers
Optum dedicated teams work full time in more than 1,000 CBOs, hospitals, and health systems around the nation. An additional, remote-review staff that researches, supports, and communicates with health plan clients every day supports these teams.

Cost recovery and error prevention
Our Credit Balance Resolution staff coordinates with the client’s internal review efforts to recover overpayments and prevent errors. Leveraging patented technologies, we identify the procedural and system issues that cause credit balances in the first place then conduct reviews to identify opportunities to prevent future overpayments.

Client services
Because our client service team understands daily business practices, we become a true partner, rather than just a vendor. This experienced team actively communicates with clients, helping them understand the reporting processes and identifying new opportunities for how to use the information in the reports to improve recovery and error prevention efforts.

Interactive reporting
We provide confidential, quarterly benchmarking summaries that compare a health plan’s performance against the industry as a whole. This actionable information is delivered to our clients via a web portal in a secure, seamless, and paperless process.

Optum Credit Balance Resolution services help:

  • Facilitate claim adjudication from both health plan and provider points of view
  • Identify opportunities to prevent future overpayments through root cause analysis
  • Prevent recurring errors and reduce ongoing errant claims
  • Improve recovery efforts and payer provider relationships
  • Streamline workflow