Category Archives: Optimizing Payment Integrity software

Ask the expert: Essentials to managing prospective payment systems

By: Heather Johnson, Manager, Process Management Payment Integrity, Optum This is the 3rd blog in a 3-part series “Optimizing Payment Integrity software to avoid payment pitfalls” Prospective payment methodologies carry opportunity and risk for payers and providers alike. It takes resources and expertise to ensure the accuracy of provider reimbursements — particularly in the face of constant […]
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Ask the expert: Save with a five-phase approach to application manager services

By: John Hoffman, Director, Application Managed Services Operations — Payment Integrity Software — Payment Integrity, OptumIT This is the 2nd blog in a 3-part series “Optimizing Payment Integrity software to avoid payment pitfalls” There is an art and science to effective claims adjudication. The science lies in more edits, which can drive 1–2% in cost avoidance. But […]
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Ask the expert: Maximizing payment integrity success through software

By: John Hoffman, Director, Application Managed Services Operations — Payment Integrity Software — Payment Integrity, OptumIT This is the 1st blog in a 3-part series “Optimizing Payment Integrity software to avoid payment pitfalls” In the dynamic health insurance industry, the claims operations organization within a payer is committed to paying a provider’s claims as quickly and accurately […]
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