WEBVTT

00:00:02.253 --> 00:00:04.540
We understand
that medical claim coding,

00:00:04.574 --> 00:00:07.936
reimbursement,
and clinical accuracy is complex.

00:00:08.078 --> 00:00:10.407
There are millions
of government regulations,

00:00:10.457 --> 00:00:13.109
industry standards,
and internal business policies

00:00:13.143 --> 00:00:15.668
that must be considered
during claim processing.

00:00:16.194 --> 00:00:18.686
Our claims edit system
accurately delivers

00:00:18.741 --> 00:00:22.533
professional and facility edits
across Medicare, Medicaid,

00:00:22.631 --> 00:00:23.967
and commercial claims,

00:00:24.120 --> 00:00:26.560
all with your existing
adjudication process.

00:00:26.844 --> 00:00:28.355
As claims enter the system,

00:00:28.401 --> 00:00:30.617
they are evaluated
against the latest state,

00:00:30.760 --> 00:00:32.520
federal, and commercial guidelines.

00:00:32.985 --> 00:00:34.426
Potential errors are flagged

00:00:34.459 --> 00:00:36.472
and reported
with recommended action.

00:00:36.854 --> 00:00:39.922
All editing decisions
are sourced to minimize appeals,

00:00:39.977 --> 00:00:42.211
and rule logic
is transparent to users,

00:00:42.259 --> 00:00:44.045
to support provider communication.

00:00:44.782 --> 00:00:48.915
Edits are developed and maintained
by a team of over 100 specialists

00:00:49.031 --> 00:00:51.248
who research
industry trends and changes

00:00:51.305 --> 00:00:53.672
to update the latest rules
across standard,

00:00:53.801 --> 00:00:55.757
specialty, and custom editing.

00:00:56.887 --> 00:00:59.490
We also offer
application managed services,

00:00:59.684 --> 00:01:02.368
with experts who act
as an extension of your team

00:01:02.512 --> 00:01:05.005
to expedite
the implementation of new rules,

00:01:05.106 --> 00:01:08.111
improve operations,
and increase savings from editing.

00:01:08.411 --> 00:01:11.518
Our AMS team will also
consult on business process,

00:01:11.543 --> 00:01:14.299
technology,
and payment policy review.

00:01:14.837 --> 00:01:16.871
Health plans using Claims Edit System

00:01:16.900 --> 00:01:21.013
average $36 to $54
per member per year in savings.

00:01:21.297 --> 00:01:23.321
And those partnering
with our AMS team

00:01:23.362 --> 00:01:28.365
can see an additional savings
of $24 to $42 per member per year.

00:01:28.503 --> 00:01:31.945
Improve your claims accuracy
and increase savings today

00:01:32.118 --> 00:01:34.277
with Claims Edit System from Optum.