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Financial solutions

Payment integrity solutions for health plans

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

Take your payment integrity program to the next level

Looking for innovative strategies to elevate your payment integrity program and address today’s most pressing market challenges? Dive into our latest insights and resources to discover how to maximize cost savings, minimize provider abrasion and make the shift to denial prevention.

Key benefits

As medical costs continue to rise, health plans are challenged to deliver cost savings without amplifying member and provider abrasion.

Maximize medical cost savings

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

Available both pre- and post-payment, our suite of solutions improves payment accuracy at every point in the claim lifecycle.

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

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.

White paper

Optimizing your payment integrity program

Learn best practices to help health plans achieve in-year cost savings goals.

White paper

Best practices for reducing provider abrasion

Find out what is driving the recent increase in abrasion and learn what health plans can do to alleviate provider pain points.

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