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.

A question of competitive position

In the dynamic industry of health care benefits administration, the many advantages of Optum™ Professional Claims can help you keep pace with change, manage medical costs, improve workflow, and serve ever-increasing populations.

Streamlining decision making processes and reducing administrative costs can yield significant savings that strengthen your ability to service beneficiaries and help you comply with ever-changing prompt-pay legislation.

Increase your savings potential by:

  • Improving the appropriateness of claims payments — automatically
  • Slashing inconsistent manual review and reallocate your resources
  • Facilitating resolution of provider appeals by basing adjudication on contracted rates
  • Reducing costs with a browser-based interface system
  • Detecting overpayments before payment
  • Enjoying responsive customer support

Advantage one: Customize your rules

  • The full impact of your claims reimbursement and editing policies can’t be felt until implemented consistently and universally. Your key to success, then, can be automation of your specific policies — through the Optum Professional Claims Rules Creation Manager module
  • Easy creation of complex new rule types — create rule logic that more precisely reflects your unique program design. Optum Professional Claims will implement your operational policy rules in addition to standard clinical rules
  • Universal policy implementation — Optum Facility Claims will accept your input of proprietary auditing logic and administer it uniformly to specific beneficiary classes, or universally, enterprise-wide

Advantage two: Increase your auditing accuracy

  • Date-sensitive auditing logic provides that claims are processed against the policies in effect at the time the services were rendered. Decrease provider appeals by paying right the first time
  • Historical processing detects duplicates, split bills, etc., for consistently appropriate reimbursement
  • Reliable documentation facilitates speedy, easy response to provider inquiries, your adjustors simply access clinical rationale off-the-shelf from the Optum Professional Claims online reference library

Advantage three: Lower your total operating costs

  • Aggressive acquisition cost — An attractive pricing structure
  • Unique browser interface — Access Optum Professional Claims through your Web browser
  • Reporting — The Optum Professional Claim robust reporting utilities and 20 standard reports can help you increase productivity and identify cost-improvement opportunities.
  • Real-time processing — Choose batch or real-time processing
  • Choose your implementation — On the front end or on the back end to identify additional savings above and beyond what you edit today