Claim denial management is complex
Health plans and providers face many challenges when trying to prevent claim denials, including:
- Lack of interoperability between health plan systems and provider workflows
- Manual processes to exchange data
- Lack of visibility into health plan-specific requirements
- Variability in health plan requirements
Enhance your claim denial management program
What if your strategy could evolve from efficiently processing claim denials to preventing them?
Optum® Comprehensive Denial Prevention is a shift-left provider education and error prevention program that will change how you think about payment accuracy and denial management. Our tools help both health plans and providers with the denial management process by:
- Reducing claim denials
- Enabling mutual transparency
- Providing greater efficiency
- Reducing administrative burden
- Increasing payment accuracy
- Improving the patient experience
Get near real-time messaging for better health care claim denial management
To reduce claim denials, we create connections between health plan claim editors and provider practice management systems. This enables billing entries or claims to be evaluated against editing rule sets before submission or adjudication.
With our tools, providers are alerted to actionable errors in near-real time. This allows them to take corrective action within their existing workflows and submit accurate, complete claims the first time.
*Gavidia, Matthew. Medical Claim Denial Rates Rising, Highest in Initial COVID-19 Hotspots. American Journal of Managed Care. January 21, 2021.