Claims Manager Flashcards
What is Optum Claims Manager?
It is an automated claims editing (“claim scrubber”) tool that reviews healthcare insurance claims for coding or billing errors before they are submitted to payers . By catching issues upfront, it ensures claims are clean and complete, helping providers avoid denials and get reimbursed correctly on the first submission .
What are the key features of Optum Claims Manager?
Key features include an advanced rules-based editing engine backed by a vast library of coding relationships  and the ability to create custom edit rules as needed . It also integrates with existing billing workflows  and automatically flags issues like coding errors or unbilled services before claims are submitted .
What benefits does Optum Claims Manager provide?
It significantly reduces claim denials and speeds up reimbursements by catching errors early . It also increases revenue by capturing missed charges , cuts down on manual rework and billing costs by preventing avoidable denials , and ensures compliance with the latest payer coding rules .
How is Optum Claims Manager used in healthcare?
Healthcare providers (from clinics to hospitals) use Claims Manager within their billing process to “scrub” claims before sending them to insurers . For example, a hospital can run Claims Manager on its inpatient and outpatient claims to catch and correct coding errors prior to submission , ensuring a higher chance those claims get approved on the first try.
What distinguishes Optum Claims Manager from other solutions?
Distinguishing features include its extensive, constantly-updated knowledge base of clinical coding rules  and the flexibility to add or customize edit rules quickly . It also delivers proven results (some clients report about a 23:1 return on investment)  and integrates seamlessly into existing systems with minimal disruption to workflows .
