Prepayment Review Solution

Prevent fraud before it happens

Optum Pre-payment Review solution uses advanced predictive analytics services to measure improper payment risk and identify anomalies in providers’ claims. It uncovers inaccuracies before claims are paid, with no disruption to the payment cycle. Optum pre-payment predictive analytics saved health plans more than $120 million in 2012, while also helping to correct payment system vulnerabilities and providing support for law enforcement.

Augment traditional recovery efforts

We process more than 200 million claims representing more than 1.4 million providers and put this predictive intelligence to use to help your organization achieve significantly greater customer savings than when using recovery efforts alone. Thorough pre-payment investigation drives more effective results for you without disrupting your overall claims process or jeopardizing your compliance with prompt pay regulations.

Prospective detection

  • Apply predictive analytics developed from real-world investigation experience
  • Augment your existing anti-fraud initiatives by identifying providers who demonstrate aberrant billing trends and patterns
  • Identify aberrant billing practices and possible fraud and abuse by mining the data to reveal hidden patterns and relationships