Optum solution uses global positioning system technology for Optum (CES) is an open-architecture claims editing tool that
Program Integrity Solutions Optum provides 30 years worth of government expertise and a full range of program integrity solutions to identify and avoid incorrect payment upfront, as well as retrospectively recover inaccurate, inappropriate or fraudulent Medicaid payments. Fraud, waste and abuse: a continuing challenge The integrity of Medicaid programs is a key priority for all program personnel. Every day, they demonstrate their dedication by revealing billing errors and correcting fraud, waste and abuse. Payment accuracy is the goal, as is a positive return on all technological investments to improve overall program integrity. Detecting fraud, waste and abuse is complex; it can run the gamut from simple coding errors or billing for unnecessary procedures to organized crime networks. To truly address the problem of fraud, waste and abuse, Medicaid program integrity processes need to evolve to detect the ever-changing face of fraud. Optum TM Program Integrity Solutions are helping to transform program integrity into a more proactive, nimble process. Up until very recently, most states have focused on retrospective recovery. Today, states are in a position to reinvent the program integrity process, by moving the identification of a potential problem to the front-end of the claims cycle before payment is made. Optum Program Integrity Solutions are an integrated set of analytic solutions presented in a web environment and backed by experienced staff to deliver actionable intelligence. The information generated increase recoveries. Optum provides: Advanced detection analytics designed exclusively for Medicaid Deep expertise in designing and using government payment and analytic systems Low-risk, well-established processes and solutions with proven results Comprehensive and flexible approaches: from services and software to business process outsourcing Results Optum Program Integrity Solutions helped 22 clients realize more than $300 million savings in 2012 alone. Washington Optum currently works with 22 government clients, saving states millions every year. Oregon Nevada Idaho Montana Wyoming North Dakota South Dakota Nebraska Minnesota Iowa Wisconsin Michigan Maine VT NH New York MA CT RI NJ Pennsylvania California Utah Colorado Kansas Missouri Illinois Ohio Indiana West Virginia Credit Balance Kentucky MD DE Virginia Washington, D.C. Arizona New Mexico Oklahoma Arkansas Tennessee North Carolina South Carolina Texas Mississippi Alabama Georgia Optum Program Integrity Clients Louisiana Alaska Florida Hawaii
Optum solution uses global positioning system technology for Optum (CES) is an open-architecture claims editing tool that
Optum Program Integrity Solutions Electronic Visit Verification Fraud and Abuse Detection System Predictive Analytics Retrospective Review and Recovery Credit Balance Services Pre-paymentent Medicaid d- Tuned Analytic cs Post-payment Social Networking/ Linkage Analysis Injury Coverage Coordination Social Networking/ Linkage Analysis (facility and professional) Medicaid Fraud Control Unit Analytics Support Program and Operational Assessments Systems Analysis and Vulnerability Assessments Policy Review Program Management
Optum solution uses global positioning system technology for Optum (CES) is an open-architecture claims editing tool that