CAC Pro Flashcards
What is Optum’s CAC Pro technology?
Optum CAC Pro (Professional Computer-Assisted Coding) is a software solution that uses AI – specifically Optum’s Clinical Language Intelligence (CLI) NLP engine – to automatically analyze clinical documentation and assign medical codes. It’s essentially an advanced coding tool that helps coders and healthcare organizations streamline the coding process by suggesting accurate diagnosis and procedure codes from the patient record.
What are the key features of CAC Pro?
Key features of Optum CAC Pro include its patented NLP engine (CLI) that reads and interprets medical records to suggest ICD-10 and CPT codes, a unified coding platform with automated worklists for coders, and integrated modules for coding review, auditing, and charge reconciliation. It also provides built-in coding edits (like CCI and LCD guidelines) and highlights the source documentation for each suggested code, giving full transparency and traceability in the coding process.
What core benefits does CAC Pro offer healthcare organizations?
CAC Pro offers several important benefits: it speeds up coding workflows (increasing coder productivity and allowing more charts to be coded in less time), improves coding accuracy and consistency (by applying uniform rules and reducing human errors), and leads to fewer claim denials with faster reimbursement (since initial coding is more often correct and compliant). It also enhances compliance and audit readiness by providing audit trails for all codes and helping ensure documentation supports the billed codes, which overall protects and optimizes revenue for healthcare providers.
How is Optum CAC Pro used in healthcare settings?
In practice, CAC Pro is used by hospital coding departments and physician group practices to assist human coders in reviewing and coding patient charts. For example, in an outpatient clinic or ambulatory surgery center, CAC Pro will pre-scan the physician’s notes and suggest codes, which the coder then verifies and sends on to billing. Some straightforward cases might be coded entirely by CAC Pro (“auto-coded”) if they meet confidence criteria, whereas complex cases are flagged for detailed coder review. Healthcare organizations also use CAC Pro’s reports and flags to support clinical documentation improvement and to prioritize coding or auditing of high-risk cases (like those affecting risk adjustment or quality reporting).
What makes Optum’s CAC Pro different from other coding solutions?
Optum’s CAC Pro is distinguished by its advanced NLP technology and comprehensive scope. Its CLI (LifeCode) engine is a patented NLP system known for deeply understanding medical language and context, which means CAC Pro can suggest codes with a high level of accuracy and minimal false positives. Additionally, CAC Pro combines multiple functions – automated coding, editing rules, audit capabilities, and charge capture – into one platform. This integration and the system’s proven performance in real-world coding (from physician clinics to large hospitals) set it apart from basic CAC tools, making it a leader in helping organizations achieve efficient, accurate, and compliant coding.
