Traditional claim processing is complex

Health plans and providers face many challenges when trying to process and pay claims accurately, 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

These complexities drive claim errors, resulting in provider inquiries via phone calls and portal transactions. This leaves health plans with millions of unnecessary SG&A spend.

Start reducing your administrative spend from claim errors

Optum® Real Edit Intelligence is a shift-left provider education and error prevention program that will change how you think about payment accuracy. We help providers correct errors at the point of care, helping health plans avoid unnecessary SG&A spend while:

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

Modernize claim processing

Health plans and providers exchange common information in real time.

Edit claims earlier in the lifecycle

Billing entries or claims are evaluated against editing rule sets before submission or adjudication, helping reduce 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 adoption with education and outreach to maximize claim correction rates and your overall program value.

Get near real-time edits for better healthcare claim processing

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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