Health care 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
Key benefits
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.
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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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.
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Brochure
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.
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PDF
Brochure
Optimize your pricing solutions
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.