""If I have to summarize it in one word, I would say the biggest challenge in claims and reimbursement is guess work," said Puneet Maheshwari, senior vice president and general manager of Optum Real, to the audience on Tuesday. "The guesswork that happens on the provider side. The guesswork that happens on the payer side leads to significant amount of work and overhead for both parties involved ....""
"According to the Minnesota company's press release, Optum Real is a "multi-payer platform [that] allows real-time data exchange between payers and providers, enabling the identification and interception of known issues at the point of claim submission." Given that Optum developed the system that promises "instant clarity," it's no surprise that UnitedHealthcare, a sister company under the UHG umbrella, is the first health plan in the country to adopt this technology."
Provider frustration over perceived insurer "delay and deny" practices has intensified, driven largely by lack of transparency and pervasive guesswork. Guesswork on both provider and payer sides creates significant additional work, overhead, and delays in reimbursement. Optum Real enables real-time data exchange across multiple payers and providers, identifies and intercepts known issues at the point of claim submission, and aims to eliminate data fragmentation that slows claims adjustment. UnitedHealthcare is the first health plan to adopt the platform. The platform targets reduced administrative costs, fewer clinical documentation improvement expenses, and faster, more accurate reimbursements for providers.
Read at MedCity News
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