Program Integrity Solutions
OptumInsight program integrity solutions provide a comprehensive suite to detect, investigate, stop, or recover inappropriate, erroneous, and fraudulent payments and help contain costs. We provide solutions that span every step of the payment cycle, from prospective (pre-payment) to retrospective (post-payment) and optimization solutions to continually refine and improve results along the way.
OptumInsight offers a unique combination of expertise in government health care programs, fraud and abuse and program integrity strategies, data analytics, and consulting to help federal and state governments restore fiscal balance and increase efficiencies.
OptumInsight program integrity solutions have saved public sector organizations more than $400 million.
Pre Payment Solutions
OptumInsight pre-payment solutions help you ensure that accurate payments for services are delivered in the first place - a more efficient way to contain costs particularly when coupled with traditional post-pay and recovery activities.
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Post Payment Solutions
Our proven recovery solutions give states comprehensive options for identifying and recovering inappropriate payments.
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Optimization Solutions
OptumInsight comprehensive Program Integrity solutions include tools and methodologies to optimize your process and improve performance.
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Payment Solutions
OptumInsight payment solutions use an established framework to help government agencies share the risk with their provider network, making sure each group is accountable for the portion of risk that they can effectively manage. This method rewards the providers delivering effective care while creating incentives for other providers to improve their care-delivery processes.
We’ll help you design payment strategies for using:
- APCs and DRGs for out-of-network claims
- APCs and DRGs for in-network commercial business
- Alternative reimbursement methodologies
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