Prepayment Solutions

Let Optum™ help you increase efficiency by paying it right the first time.

Avoid Errors, Contain Costs

Optum pre-payment solutions improve the integrity of the payment process and effectively contain costs by identifying erroneous and inappropriate claims before payment is made. That way, you prevent rather than recover inappropriate payments. It’s a more efficient approach, particularly when coupled with traditional post-payment and recovery activities. Our pre-payment solutions can help you:

  • Apply advanced predictive analytics services to identify risk and anomalies with no disruption to the payment cycle
  • Identify errors and inaccuracies before the claim is paid, allowing upfront correction by providers
  • Automatically review and edit claims submitted by providers and facilities
  • Ensure accident claims are paid by the appropriate parties
  • Reduce or eliminate overbilling and overpayment
  • Identify fraud and potential fraud networks

 

 

Claims Editing System iCES for Facility Claims

Catch Coding Errors Before They Happen

See why more than 65 health plans use the Optum™ Claims Editing System to streamline claims processing workflows, reduce reimbursement errors and improve payment integrity.

Claims Editing System iCES for Professional Claims

Fine-tune your operations

Optum™ Professional Claims enables you to fine-tune your operations for seamless claims processing with fast turnaround times and minimal administrative burden.

Injury Coverage Coordination

Get claims closed

You want your claims paid. Optum™ can help. With a potent combination of proprietary analytics, accurate case identification, and superior communication, we help close 90 percent of claims within 15 calendar days.

Optum Electronic Visit Verification

Ensure accountability

The Optum™ Electronic Visit Verification solution is a reliable and cost-effective solution that helps more efficiently deliver care by improving payment accuracy, program integrity and overall patient care. Using global positioning system (GPS) technology, Electronic Visit Verification provides a platform for measuring, recording and verifying home health caregivers and transportation services in real time.

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.