Claims Administration

Denied claims are a major roadblock to your organization's success. Current research shows denial rates for hospitals and medical practices can range from 5% to 10%. with the industry set best practice at 5%. 5% may seem small, but at an average cost of $25 per claim, these rejected claims increase your costs, create longer accounts receivable cycles and affect the rate of collection. When a claim is denied, or items are unbilled, your organization's cashflow is unpredictable, your patients are frustrated and your productivity and profitability suffer.

How much? Organizations traditionally spend 10% of their annual billings in denial management. These high additional costs and burdens of processing medical claims should not be accepted as the price of doing business with payers. What if you could stop these errors before they happen? What if you could prevent clinical and coding denials? Optum Claims Manager helps move your organization toward a reliable and consistent approach for processing claims.

It's a proactive system that will identify certain to deny claims and unbilled items based on how the payer will adjudicate the claim, reducing your expenses, increasing cashflow and freeing your staff from needless administrative tasks. Optum Claims Manager lets you address incorrectly coded charges when it matters most, before they ever happen. Automatically pre-screen claims for clinical coding and billing errors against the industry's largest knowledge base of more than 129 million code to code relationships maintained by a staff of more than 140 industry experts.

These consistent automated edits help you comply with Medicare, Medicaid, commercial payers and the Blues. And unlike clearinghouse edits or claim scrubbers, they're based on an industry standard and backed by sourcing statements. You can even develop your own edits and customize system edits to meet your organization's specific billing and reimbursement needs. Optum Claims manager helps your business stay ahead of rapidly changing regulations and minimize administrative costs.