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Resolve credit balances and recover claim overpayments

Health plans face many challenges when it comes to identifying and recovering claim overpayments, including:

Lack of resources
Rising costs
Rapidly changing mandates
High payment volume

Optum® Credit Balance resolution and recovery services help health plans research and resolve unsolicited and solicited overpaid claims. We help maximize your overpayment recoveries across all lines of business to reduce medical spend, administrative costs and recovery time.

Maximize savings through claim overpayment recovery

Working as an extension of the provider office, we identify, research and resolve credit balances on behalf of our health plan clients.

Improve the recovery process

Our expert-led, technology-driven process reduces recovery turnaround time while maximizing your administrative and medical expense savings.

Strengthen provider relationships

Our team collaborates with more than 1,500 providers every day to research and resolve overpaid claims, minimizing provider abrasion.

Prevent future claim overpayments

With advanced analytics, we identify issues and ongoing errors causing claim overpayments, providing opportunities to prevent them in the future.

Unlock additional savings with our Credit Balance recovery services

With more than 25 years of recovery experience and a large, nationwide network of providers, we combine leading-edge technology with human expertise to help health plans resolve credit balances and maximize overpayment recovery. Our results:

More than $1 billion in Credit Balance recoveries in 2025*
1,500 providers in our recovery network*
98% recovery client retention rate*

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Frequently asked questions about recovery services

To recover overpayments, health plans use analytic tools and automated workflows that examine claims for discrepancies, identify payment errors and help resolve credit balances efficiently. These solutions support both health plans and providers by clarifying the origin of an overpayment and facilitating timely refunds.

Effective credit balance resolution reduces financial waste, can help smooth operational processes and helps foster a more transparent relationship between health plans and providers — all while minimizing unnecessary administrative friction.

Credit balances can arise for several reasons, including duplicate payments, claim adjustments occurring after initial processing, misapplied funds, retroactive eligibility changes and coordination of benefits corrections. Without proper identification and follow-up, these credits may remain unresolved and distort financial records.

Unresolved credit balances may trigger audit concerns, expose health plans to regulatory penalties and signal deficiencies in internal payment controls. This is particularly important in government-regulated programs, where adherence to reimbursement standards and reporting requirements is tightly monitored. In addition to compliance issues, unaddressed credits contribute to operational backlogs and can damage provider relationships if not managed consistently and transparently.

Yes. Advanced analytics — including rules‑based logic, anomaly detection and automated prioritization — play a significant role in identifying outstanding credit balances. These tools help plans detect patterns, flag high-risk transactions and help streamline workflows so staff can focus on the most impactful cases. By improving accuracy and reducing manual workload, analytics can enable faster, more reliable resolution of credits while supporting overall financial integrity.