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I think we're at an inflection point within the health care system.
With modern advancements in technology, connectivity,
we're going to be able to make the next big leap,
which is going to take costs out of the health care system,
by getting rid of administrative waste and errors.
My name's Paul Root.
and I lead the payer administration product team within Optum Insight.
The problem with claim denials
is it creates friction in the claim process.
As claims are submitted from physicians,
health systems, to health plans,
every health plan has a process where they evaluate those claims
to make sure they're coded correctly,
that they are billed in accordance with
the payer's payment policy.
Oftentimes, that results in a denial,
which is a claim that then is sent back to the provider
that they have to do something with.
Now they have to recheck it.
They have to research what was wrong.
They have to try to fix the claim and resubmit.
So we get into this sort of back and forth
and we're trying to avoid the back and forth.
At Optum, we're creating connections
between the payer and the provider.
We're integrating into the provider's EHR
and into the payer's adjudication system.
And we're able to share information
that's required for an accurate claim upfront,
in the provider's workflow, as they're coding that claim,
to avoid denials in the long run.
If we can just connect the dots,
if we can create connectivity using AI and analytics,
we can remove waste from the health care system.
And that's really what we're trying to do.
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