Optum, Inc.: Company Analysis

Subject: Company Analysis
Pages: 4
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What is Optum360?

Optum360 is a vendor that sits at the center of the health care financial exchange. They create a clear, aligned, financial ecosystem, and combine technology, methodology and expertise to help payers and providers collaborate. Their seamless, transparent revenue cycle capabilities strengthen and sustain the payer and provider relationship.

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Building innovation across the revenue cycle

Optum’s solutions leverage clinically aware artificial intelligence. And they are infused with the experience of countless experts. The company builds connections between cost and care to advance the revenue cycle for long-term growth.

Optum360 solutions span the revenue cycle from end-to-end; patient financial experience, documentation and coding accuracy, claims integrity and processing, and denials management and recovery.

Patient Financial Experience

Optum360 elevates the patient’s financial experience across their entire encounter. Built-in payer-provider connectivity helps verify insurance eligibility and treatment authorization instantly, easing uncertainty for both health organizations and their customers.

For patients, this means accurate estimates of out-of-pocket obligations and easy payment options even before care is delivered. For health systems, it accelerates collection at the point of service, reduces denials and improves patient satisfaction.

Coding and Documentation

Optum brings artificial intelligence into revenue cycle operations to help achieving regulatory compliance and proper reimbursement. Our proprietary natural language processing comprehends clinical documentation, identifies discrepancies and applies appropriate coding.

Their AI technology and clinical and regulatory experts help to create a high-performance environment. They surround core systems with a rich combination of technology and expertise. This curbs errors, speeds reimbursement and improves financial performance.

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Patients gain accurate quality reporting, improved medical necessity determinations and reduced denials. By attaining complete and accurate documentation and coding, patients reduce friction with payers, rework and lost revenue.

Claims

Optum360 streamlines the claims process from preparation and submission to payer response. Its powerful content and rules-based editing can eliminate needless feedback loops between providers and payers. It screens and corrects claims even before they leave your system.

This proactive approach improves claims integrity and boosts first-pass payment rates. This protects health organizations from avoidable rework, delays and denials. And our service and support teams keep you compliant with payer regulations and guidelines.

Reimbursement

Bring in best-in-class services powered by today’s leading technology to reduce denials and improve A/R recovery. Optum customizes every relationship and satisfy short-term resource demands or design long-term engagements for operational efficiency.

With Optum360, patients have access to dedicated, experienced resources who understand payer rules and regulatory guidelines. Patients get help with immediate needs along with guidance on options to help to sustain performance, efficiency and accuracy.

Their experts, technology and managed services combine to help patients rapidly improve cash flow, address staffing needs and develop long-term process improvements. Explore options for cost-effectively managing denials, A/R, underpayments and secondary claims.

Payer-Provider Connectivity

Optum360 supports real-time communication and financial exchange between health systems and the groups that reimburse them. Automated sharing of clinical and claims data eliminates needless “back and forth” and administrative friction from payer-provider relationships.

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Building data-sharing power into the revenue cycle improves transparency and efficiency across the entire care system. For providers and payers alike, that means smoother transactions, increased claims accuracy, reduced rework and predictable financial performance.

Market Performance Partnerships

Optum360 delivers predictable value for health systems with a partnership model that optimizes revenue cycle financial performance through a strategic infusion of commercial technology, people and innovation.

They deliver pre-negotiated outcomes based on an optimal future state of operation and take financial risk on that delivery. They take on accountability, predictable cost and revenue expectations, allowing customers to focus on providing high-quality patient care.

Their technology, analytics and disciplined and scaled operations remove inefficiencies in the revenue cycle. They span patient access, coding and documentation to claims processing and denial management.

Only Optum360 has the breadth and depth to help you achieve financial and operational predictability.

Through this model partners can:

  1. Improve documentation standards.
  2. Identify process and care gaps.
  3. Strengthen payer-provider collaboration.
  4. Remove administrative waste.
  5. Enhance the patient experience.

References

Optum, Inc. (2021). Move forward. Web.

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