Tag Archives: Health Plans

Blockchain enables powerful connections and better care

There is a lot of hype around blockchain — a new type of digital ledger, where transactions are chronologically recorded and tamper-resistant. Blockchain ledgers are decentralized, so all members see and own the information cooperatively, with no middleman. Many experts believe blockchain will be as big a disrupter as the internet. This view is supported […]
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Anticipating MACRA and Medicare Advantage impacts

MACRA continues to evolve and while its impacts may have been somewhat softened over the last several months, MACRA’s intent is still to have an impact on care costs and quality over short and long term. While many providers are concerned and strategizing about the financial and administrative implications of MACRA, payers should also consider […]
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Viewpoint: Part 1 of the 2019 CMS Advance Notice

By: Rich Gamret, FSA, MAAA, Director, Actuarial Consulting, Optum CMS recently released Part 1 of the 2019 Advance Notice of Methodological changes for Medicare Advantage. This was a first for the industry — this information has historically been released in February. As required by the 21st Century Cures Act, CMS is focused on improving the […]
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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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Ask the expert: Key steps to evolve to a pre-payment strategy

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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Ask the expert: Key steps to optimize an existing post-payment strategy

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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Ask the expert: What makes Optum the right comprehensive payment integrity partner?

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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Ask the experts: How can we transition to comprehensive payment integrity?

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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