case study
Case study: Decrease leakage of claim denials
Validate claims payment decisions with a secondary editor.
Minimize overpayments and capture savings
A Blues plan sought to improve payment integrity automation and reduce spending. Optum deployed system edits and targeted custom edits. This helped the plan increase auto-adjudication rates, resulting in $9 million in annual incremental auto-deny savings.
Claims Edit System (CES) Second Pass
Learn how our second-pass editor helps health plans avoid payment leakage with a second line of defense. Health plans can use CES Second Pass to prevent costly overpayments, improper payments, delayed payments and delayed recoveries.
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