Skip to main content

Healthcare operations

Comprehensive Denial Prevention

Prevent healthcare claim denials and reduce administrative waste.

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

We help health plans and providers evolve from efficiently processing claim denials to preventing them while:

  • Enabling mutual transparency
  • Providing greater efficiency
  • Reducing administrative burden
  • Increasing payment accuracy
  • Improving the patient experience

Denial prevention for health plans and providers

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.

Get near real-time messaging for better healthcare claim denial management

We create connections between health plan claim editors and provider practice management systems to evaluate billing entries or claims against editing rule sets before submission or adjudication. Providers are alerted to actionable errors in near-real time, allowing them to take corrective action within existing workflows and submit accurate, complete claims the first time.

Related healthcare insights

E-book

Achieve claim pricing accuracy and efficiency

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

Article

Enhancing fraud investigations with AI

Learn how AI is changing the fraud case review process.

Infographic

Best practices for identifying overpayments

Learn how a multi-tiered approach to data mining helps maximize savings and achieve payment accuracy earlier in the claim lifecycle.

Start reducing claim denials with Optum Comprehensive Denial Prevention

Complementary solutions

Claims Edit System

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

Emergency Department Claim Analyzer – Facility

Control rising emergency outpatient facility costs with automated, consistent and defensible E/M coding evaluation.

*Gavidia, Matthew. Medical Claim Denial Rates Rising, Highest in Initial COVID-19 Hotspots. American Journal of Managed Care. January 21, 2021.