As health care becomes more complex, the consumer experience is getting more fragmented, which makes it all too easy for people to feel overwhelmed and frustrated. This is not good. For one thing the industry is trying to improve health, not make it worse by leaving a trail of exasperated consumers. What’s more, health care […]
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There isn’t a single cure to address all of the challenges facing our health system, but there is a common goal. We all want a health system that treats patients compassionately, allocates resources efficiently, and provides quality care to those who need it — all without bankrupting ourselves or future generations. Too often we pursue […]
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Each year at Optum Forum we present the latest advancements in services and solutions aimed at how well gets done. This year’s event included the launch of OptumIQ™ and Optum Performance Analytics. Now we’re learning what attendees think about these initiatives. Massachusetts-based International Data Corporation (IDC) reviewed Optum Forum 2017 and the initiatives unveiled there. […]
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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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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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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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By: Erin Schmuker, Vice President, Product Solutions – Payment Integrity, Optum This is the final blog of our 2 part series “Maximizing post-payment recovery, preparing for pre-payment success“ Your transition to pre-payment success can be a natural extension of your post-payment efforts to create a comprehensive payment integrity strategy. How? The first step is to look […]
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By: Erin Schmuker, Vice President, Product Solutions – Payment Integrity, Optum This is the 1st blog of our 2 part series “Maximizing post-payment recovery, preparing for pre-payment success” There is an increasing focus on pre-payment. However, your organization may not be able to fully commit to a comprehensive payment integrity approach. Even the most robust […]
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By: Rob Mayer, Vice President, Product Strategy – Payment Integrity, Optum This is the final blog of our 3 part series “Uncover hidden funds with comprehensive payment integrity“ There are many talented payment integrity vendors. There are also many niche vendors that provide consultative, software-based or service-based solutions focusing on specific aspects of payment integrity. […]
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By: Rob Mayer, Vice President, Product Strategy – Payment Integrity, Optum This is the 2nd blog of our 3 part series “Uncover hidden funds with comprehensive payment integrity“ If you want to maximize your ability to recover inappropriate claim payments and overpayments and reduce administrative costs, a comprehensive payment integrity strategy will help you achieve […]
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