Patient Financial Clearance Flashcards
What is Optum’s Clearance solution?
It’s a pre-service financial clearance platform for healthcare providers. Clearance verifies a patient’s insurance coverage, estimates their out-of-pocket costs, and secures payment or financial assistance before treatment – all to reduce claim denials and speed up reimbursements . In other words, it helps confirm that patients are “cleared” financially (eligibility and payment-wise) prior to receiving care.
What are the core features of the Clearance solution?
Key features include real-time insurance eligibility verification (with connectivity to many payers), an integrated coverage discovery tool to find any undisclosed insurance , and an all-in-one dashboard that combines patient benefit info, registration quality checks, and point-of-service payment posting . It also automates pre-authorization and medical necessity checks, provides accurate cost estimates for patients, and has built-in charity screening for those needing financial assistance
What benefits does Optum’s Clearance provide to healthcare organizations?
Clearance helps healthcare providers in several ways. It cuts down on insurance denials by catching errors and missing info upfront, and it accelerates payments so providers get paid faster . By automating front-end tasks, it improves staff efficiency and reduces manual work, which can lower admin costs . It also increases collections (capturing patient payments and uncovering all insurance coverage) and enhances patient satisfaction through price transparency – no more surprise bills
How is the Clearance solution used in practice within healthcare?
Hospitals and clinics use Clearance during the patient intake/registration process. For example, before a patient’s visit or surgery, staff launch Clearance to verify the patient’s insurance eligibility and benefits, check if any prior authorization is needed, and determine the patient’s expected costs . They can then discuss payment arrangements or assistance with the patient ahead of time. Essentially, Clearance is used as a front-end revenue cycle tool to ensure every patient is financially vetted and cleared – which means fewer billing issues and faster billing after the visit.
What distinguishes Optum’s Clearance solution from other patient access tools?
One distinguishing aspect is its comprehensiveness – it handles the entire financial clearance process (eligibility, authorizations, estimates, payments) in one integrated suite, rather than requiring multiple separate systems . It also offers advanced capabilities like coverage discovery, which uses analytics to find insurance coverage a patient may not have disclosed (so providers don’t miss a payer) . Another unique feature is its propensity-to-pay scoring and built-in charity screening; the system can predict a patient’s likelihood to pay and flag those who may qualify for financial assistance, all within the normal workflow  . These features – along with seamless EHR/HIS integration and real-time updates – set Clearance apart as an end-to-end solution for patient financial clearance.
