Streamline operations
With all the challenges faced by health plans and insurers today — from increased government regulation and MLR to soaring administrative and medical costs — finding and capitalizing on every possible efficiency throughout your organization is an absolute necessity.
Issues and challenges
Avoiding costly inaccuracies
Overpayments. Unnecessary medical costs. Complexity. We help health plans keep their payment streams cleaner, more accurate, and more transparent – so the right claims get paid at the right time and the right price.
Optimizing connectivity
How can health plans ensure both HIPAA 5010 and ICD-10 compliance while improving operational effectiveness and minimizing business disruptions? OptumInsight helps build the foundation for health information exchange while also minimizing the time and cost required to migrate to new standards.
Building a strong provider network
Effective, yet efficient, provider networks are critical assets for health plans. But with limited resources, it is a struggle to develop an ongoing strategy for analyzing, monitoring, and maintaining them. OptumInsight helps plans uncover network gaps and recruit providers that improve market position as well as meeting state and federal regulations regarding credentialing.
Opportunities
Coding, Billing, and Reimbursement
Increase cash flow by coding and billing more efficiently and reducing claim delays and denials. Process and map between ICD-9 and ICD-10 indexes to ensure accuracy, support medical necessity edits for past medical claims, and minimize interruptions to disease tracking and outcomes studies.
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Electronic Data Interchange EDI
Ensure HIPAA 5010 compliance with preproduction testing and certification- as well as production validation and routing solutions. Increase overall efficiency and productivity with next-generation EDI solutions. Automate critical operational processes. Streamline transactions with providers. Access a wealth of real-time patient and reimbursement information to easily track claims.
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Payment Cycle Management
Improve end-to-end claims processing performance. Save time and money by identifying fraudulent and abusive claims for investigation before the claim is paid. Leverage the established framework of Medicare’s Prospective Payment System to decrease the cost of care – “pay as Medicare pays,” which can reduce in-network reimbursement costs by 25 percent. Achieve a consistent and reliable claims review process with claim adjudication, compliance, and reimbursement innovations:
- Reduce the time to review claims
- Accurately and efficiently review claims
- Decrease administrative expenses
- Maximize consistency in claims processing
- Achieve ICD-10 compliance with efficient code mapping and translation
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Provider Network Operations Efficiency
Cost-effectively gather, verify, and manage provider data. Reduce expenses and hassles by using fully accredited OptumInsight credentialing solutions to authenticate data and licensing for facilities from hospitals and surgery centers to home health agencies and long-term care providers.
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