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Financial solutions

Payment integrity solutions for health plans

Improve payment accuracy and maximize medical expense savings across the claim lifecycle.

Improve payment accuracy without amplifying abrasion

As medical claim costs continue to grow, health plans are challenged to deliver cost savings without amplifying member and provider abrasion. We offer a suite of fully integrated, end-to-end solutions that help health plans effectively and efficiently manage medical expense.

Available both pre- and post-payment, Optum® Payment Integrity solutions improve payment accuracy at every point in the claim lifecycle while reducing the administrative burden on providers.

Key benefits

Our suite of Payment Integrity solutions can help you achieve 8%-10% medical cost savings annually.

Industry-leading content and analytics

Our expansive content and analytic libraries enable more precise claim selection and help you address emerging drivers of medical expense.

Improve the provider experience

Our digital-first tools and educational resources reduce the burden of managing billing errors and medical record requests for providers.

Shift to prevention

We’re working directly with providers to build transparency, simplify reimbursement and prevent avoidable denials.

Payment Integrity solutions

Coding Advisor

Help providers reduce common billing errors with a proven education solution.

Claim Pricing solutions

Improve the accuracy and efficiency of your prospective payment system pricing.

Claims Edit System

Achieve clean claims and maximize medical spend savings with our flexible, real-time claim editing software.

Claim Review

Prevent improper payments, reduce medical spend and minimize provider abrasion with our comprehensive suite of pre- and post-pay solutions.

Coordination of Benefits

Identify and validate primary policy coverage with accurate eligibility data.

Subrogation for health plans

Identify, investigate, recover and prevent inaccurate payments linked to accident-related medical and disability expenses.

Credit Balance resolution services

We help health plans identify, research and resolve overpaid claims.

Optimize your payment integrity program

Optimize your payment integrity program with our Comprehensive Payment Integrity Assessment. Our team of experts will analyze your current program to identify gaps and opportunities for improvement, providing you with a strategic roadmap to modernize your payment integrity office and increase medical spend savings.

Related healthcare insights

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E-book

Achieve claim pricing accuracy and efficiency

Learn how to create a framework that drives payment accuracy on the first pass.

Video

Achieving success in claim editing

Learn how a flexible editing program can help your plan solve editing challenges, enforce policies, improve accuracy and increase savings.

Article

Enhancing fraud investigations ai

Learn how AI is changing the fraud case review process.

Take your medical cost savings to the next level with Optum Payment Integrity