Tag Archives: value

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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Ask the expert: Why consider comprehensive payment integrity?

By: Steve Yurjevich, Vice President and General Manager, Payment Integrity, Optum This is the 1st blog of our 3 part series “Uncover hidden funds with comprehensive payment integrity“ Where do you find the resources to fuel your strategic objectives? What if a more holistic approach to payment integrity could reduce your medical spend, reduce administrative […]
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Achieve breakthrough cost savings: Five first steps

By:  Zahoor Elahi, Senior Vice President, Strategic Product Management, Optum This is the final blog of our eight part series “Bending the Cost Curve with Comprehensive Sourcing.” Once you’ve considered how comprehensive sourcing can maximize cost savings beyond traditional models, what do you do next? It’s time to make a five-point readiness plan based on […]
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Gaining traction: How to discuss comprehensive sourcing with stakeholders

By:  Brian Murray, Senior Vice President, Optum This is the 7th blog of our eight part series “Bending the Cost Curve with Comprehensive Sourcing.” You may see the benefits of comprehensive sourcing, but what will it take to gain traction for the approach internally? Here is what payers tell us they want, and these insights […]
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