Healthcare claim pricing is complex
With provider contracts, claim data, federal and state regulatory requirements and business policies all contributing to the claim pricing process, it can be challenging to coordinate payment accuracy and timeliness.
Optum® Claim Pricing solutions can help you achieve more accurate claim pricing through automation, enhancing auto-adjudication rates and creating pricing transparency. Our comprehensive suite of pricing solutions includes:
- EASYGroup™, an integrated grouping and pricing engine that automates the accurate editing, grouping and pricing of claims across multiple care settings
- Payment System Interface (PSI), a web-based claim pricing platform that helps create pricing transparency and keeps you compliant with current regulations
- Application Managed Services (AMS), a dedicated team that provides ongoing support to help you make the most of your claim pricing software
Achieve more accurate, efficient claim pricing
Optum Claim Pricing solutions drive first-pass adjudication and create greater pricing transparency.
Flexible
Our Claim Pricing solutions integrate with any claim adjudication platform and can be deployed onsite or via the cloud.
Transparent
Our pricing worksheets share step-by-step pricing calculations for each claim, ensuring pricing accuracy and creating transparency.
Experienced
Every year, more than 80% of Medicare Advantage facility claims are processed using Optum Claim Pricing solutions.
Improve claim pricing accuracy with automation
Optum EASYGroup automates the process of accurate claim editing, grouping and pricing across multiple care settings, enhancing auto-adjudication rates and improving provider relationships.
Create greater pricing transparency
Payment System Interface is a web-based claim processing platform that enables individual claim review, batch processing, advanced modeling, analytics and reporting. PSI helps health plans across all lines of business create greater pricing transparency, improving pricing accuracy and provider relationships.
Optimize your pricing solutions with Application Managed Services
Maximize your organization’s investment with Application Managed Services. We provide access to a dedicated AMS support team to help you with the entire PPS process — from installation, validation and maintenance to regulatory insights and ongoing support.
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