Claim denial management is complex
Health plans and providers face many challenges when trying to prevent claim denials, including:
- Lack of interoperability between health plan systems and provider workflows
- Manual processes to exchange data
- Lack of visibility into health plan-specific requirements
- Variability in health plan requirements
Optum® Comprehensive Denial Prevention is a shift-left provider education and error prevention program that will change how you think about payment accuracy and denial management.
Enhance your claim denial management program
What if your strategy could evolve from efficiently processing claim denials to preventing them? Our tools help both health plans and providers with the denial management process by:
- Reducing claim denials
- Enabling mutual transparency
- Providing greater efficiency
- Reducing administrative burden
- Increasing payment accuracy
- Improving the patient experience
Key benefits
Did you know 86% of claim denials are preventable?* Our leading-edge technology can help you stop processing denials — by avoiding them.
Edit claims earlier in the lifecycle
Billing entries or claims are evaluated against editing rule sets before submission or adjudication, preventing denials and reducing waste.
Support accurate claim submission
Providers are alerted to actionable errors in near-real time, enabling them to take corrective action within their existing workflows.
Engage providers proactively for success
We help drive denial prevention adoption with education and outreach to maximize claim correction rates and your overall program value.
Related healthcare insights
E-book
Learn how to create a framework that drives payment accuracy on the first pass.
Video
Learn how a flexible editing program can help your plan solve editing challenges, enforce policies, improve accuracy and increase savings.
Product information and resources
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PDF
Brochure
Get near real-time messaging for better health care claim denial management
To reduce claim denials, we create connections between health plan claim editors and provider practice management systems. This enables billing entries or claims to be evaluated against editing rule sets before submission or adjudication.
Complementary solutions
Claims Edit System
Emergency Department Claim Analyzer – Facility
*Gavidia, Matthew. Medical Claim Denial Rates Rising, Highest in Initial COVID-19 Hotspots. American Journal of Managed Care. January 21, 2021.