Optum Comprehensive Denial Prevention for health plans

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® Real Edit Intelligence 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 84% 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 edits 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.

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