Injury Coverage Coordination Overview

Leverage powerful analytics and experienced investigators

Our tools allow you to intensify recovery efforts and have confidence that claims are paid by appropriate parties. Motor vehicle accidents, medical negligence, work-related accidents, premise liability, and defective product injury cases are among those investigated to determine liability responsibility.

OptumInsight enables health plans to:

• Mine claims data to identify potential cases
• Expedite case resolution
• Report progress and performance

Accurate identification of potential cases

Applying proprietary analytics techniques developed by trained biostatisticians, Optuminsight mines claims data and identifies accident-related injury cases on a daily basis. Claims history can be reviewed, and first- through fourth-level diagnosis codes are scrutinized to determine if potential third-party liability exists.

Effective communication with plan members

When a case is identified for injury coverage coordination, Ingenix investigators initiate mail and telephone communications with the plan member. Fifty dedicated call center professionals, including bilingual staff, accept member calls daily. Accurate case identification and communication help close 90 percent of claims within 15 calendar days.

Prevent and recover accident-related medical expenses

Optuminsight investigators can coordinate with other insurance carriers to apply workers’ compensation, automobile policies, and other coverage before the health insurer addresses claims. If the health plan has already paid, Optuminsight subrogation professionals negotiate and, when necessary, litigate to secure reimbursement on the health plan’s behalf.