Diagnosis-related group (DRG) outlier
For a Blues plan, Optum clinical staff found dosages for the identified medication far exceeding the recommended maintenance dose for a neonate. This saved our client nearly $600,000, more than one-fourth of the billed charges.
Itemized Bill Review
Our targeted clinical and financial review leverages Centers for Medicare and Medicaid Services (CMS) and clean-claim evaluation to review inpatient facility claims. We work in concert with our clients’ provider relations team, which minimizes provider abrasion.
Related resources
Case study 1: High-dollar claim savings
DRG outlier identified, resulting in $200,578 savings.
Perspectives on health plan trends
Together, we are driving toward the same things for our health care system — better quality, lower cost, and higher consumer and provider satisfaction.
Comprehensive payment integrity savings
Inform and improve your entire claims management lifecycle.
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