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.

Overpayment Recoveries:

  • Quickly identifies overpayments for recovery
  • Includes follow-through on payment plans to facilitate accurate payment
  • Improves relationships with professional processes and positive interaction

Overpayment Recoveries is just one component of the Optum™ Program Integrity Solution Suite, which includes:

Pre-Payment solutions
  • Prospective Fraud and Abuse Detection
  • Injury Coverage Coordination
  • Third Party Liability Data Match
  • Optum Claims Editing System (iCES®)
Post-Payment solutions
  • Retrospective Fraud and Abuse Detection and Recovery
  • Data Integration, Data Mining, and Analytics Services
  • Credit Balance Services
  • Retrospective Reimbursement Review and Coordination of Benefits
  • Overpayment Recoveries
  • Estate Recovery
  • Subrogation
Optimization tools and solutions
  • Systems Analysis and Vulnerability Assessments
  • Our services augment existing efforts of Medicaid and its providers to communicate, resolve and recover claims overpayments

Using Optum™ Overpayment Recoveries can help you realize significant savings. For example, depending on the actual proportion of Medicaid spending in a given state on fee-for-service claims, the proportion of claims related to inpatient care and clinic-related care, and the actual rate of overpayments, additional revenue from implementation of our solutions could range from as low as $500,000 to well over $5 million.