Achieve claim pricing accuracy and efficiency
Create a framework that drives first-pass adjudication.
Best practices in claim pricing
Claim pricing is complex. Provider contracts, claim data, federal and state regulatory requirements, industry trends and business policies all contribute to the claim pricing process. As a result, it can be challenging to coordinate payment accuracy and timeliness.
At Optum, we engage with our health plan partners’ leadership teams across all lines of government and commercial business to understand their pricing challenges. In this toolkit, our experts take that experience and share viewpoints on creating a claim pricing framework that will drive both accuracy and efficiency.
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