Claims Edit System
Our first-pass and secondary editing capabilities combine advanced technology and a wide range of content. We solve the largest editing challenges, improving claims accuracy and increasing savings.
Video
Solving editing challenges
Claims Edit System combines scalable, fully automated technology with robust content maintained by a team of specialists, medical directors and more. You can edit claim errors automatically for clinical coding and billing using a broad set of industry rules, regulations and policies. A dedicated support team helps seamlessly implement the system. They also assist with editing standard, specialty and custom rules.
CES Video Transcript
[Narrator] We understand that medical claims coding, reimbursement and clinical accuracy is complex. There are millions of government regulations, industry standards and internal business policies that must be considered during claims processing. Our Claims Edit System accurately delivers professional and facility edits across Medicaid, Medicare and commercial claims in a first or second pass position all within your existing adjudication process. As claims enter the system, they are matched against the latest state, federal and commercial guidelines in alignment with standard, specialty and custom edits. Potential errors are flagged and reported with recommended action. All edits are cited and rule logic is transparent to improve provider communication and minimize appeals. Findings are supported by a team of over 100 specialists who continually update our proprietary knowledge base. Savings average 4.5% on professional claims and 1.5% on facility claims. We also offer a team of client advocates who act as an extension of your team to expedite the implementation of new rules, improve operations and increase the volume of edits. Our advocates also consult on business process, technology and payment policy review. This model delivers an incremental dollar 10 PMPM in savings on average. Improve your claims accuracy and increase savings today with Claims Edit System from Optum. Optum is focused on empowering accurate effortless payments for all by providing solutions at every touch point in the billing and claim life cycle.
Automated technology
It's more than an unbundling and editing tool. Claims Edit System features flexible editing functions and complete customization logic for proprietary business rules. The system automates claims review to catch errors, omissions and questionable coding.
Application Managed Services
Manage and maximize Claims Edit System with a dedicated Application Managed Services team that provides ongoing assistance. Our physician-led ideation team combines many levers to detect cost-saving opportunities to help you increase savings and ROI.
Robust, comprehensive content
In addition to national standard edits, including facility, professional, Medicare and Medicaid, we developed edit content for specialty analytic suites. These include specialty pharmacy, genomics and emergency services, among others.
Extend your editing capabilities
Fact sheet
Professional claims
Gain a wide set of core rules that use historical data to enhance your auditing capabilities for commercial, Medicaid and Medicare claims.
Fact sheet
Facility claims
Review and catch errors, omissions and questionable coding relationships automatically for commercial, Medicaid and Medicare claims.
Fact sheet
NCD/LCD
Add Medicare editing specific to National Coverage Determinations (NCD) and Local Coverage Determinations (LCD).
Fact sheet
National and state Medicaid
Deliver Medicaid-specific editing to help maximize your claims accuracy, as well as administrative and clinical information workflows.
Solution page
Emergency department
Manage emergent spend with editing content for outpatient emergency department facility and professional claims.
