Detect, recover and prevent claim overpayments

Healthcare claim payments are complex, leaving ample room for inaccurate payments to slip through. Health plans can implement Optum® Data Mining, both pre- and post-pay, to help improve payment accuracy, reduce overpayments and save on medical and administrative costs without requesting provider documentation.

Our robust Data Mining solution can:

Facilitate compliance with provider contracts
Identify and resolve outlier billing errors
Conduct reviews on adjudication and coding errors
Prevent future errors and overpayments

Maximize savings with pre- and post-pay Data Mining

Health plans save an average of $1.96 PMPM (per member, per month) with our comprehensive, integrated solution.

Blend technology and human intelligence

Our 4-tier analytic process and expert analysts review and deny errant claims before payment and identify overpayments already reimbursed.

Find errors across multiple categories

We identify and prevent claim errors including duplicates, billing issues, coordination of benefits and contract administration.

Shift from recovery to prevention

Our advanced analytics pinpoint the root cause of claim overpayments and apply learnings to prevent future claim errors.

Increase transparency through collaboration

We share concepts and analytics with health plans to help optimize their programs and work with providers to explain and prevent errors.

Drive more value from your data mining solution

We bring unmatched data mining expertise and experience to help health plans achieve payment accuracy and reduce medical and administrative costs. Our results: