Managed care at Optum

PPO

Hospital and physician expenses present significant opportunity for savings. Through a combination of national affiliations, and regional and proprietary networks, our PPO network service:

  • Ensures seamless access to experienced, credentialed providers
  • Delivers savings through assertive contract negotiations
  • Includes rigorous credentialing standards and persistent monitoring of provider qualifications and performance
  • Prospectively applies treatment protocols from the inception of medical treatment
  • Provides reliable, actionable PPO network data

Many PPO networks can produce high penetration rates and savings. Only we have the quality of network, data integrity and processes to increase savings, simplify administration and improve outcomes, both clinically and financially.

Provider Treatment Portal

Medical Bill Review

When it comes to medical bill review, our technology is only half the story. Our knowledgeable and experienced in-house professionals leverage data and automated processes to complete timely, accurate, professional-level clinical reviews. As a result, clients realize maximum savings as the medical bill review process:

  • Combines national coverage capabilities with regional networks
  • Applies national coding parameters
  • Detects improper billing practices and duplicate entries
  • Integrates all utilization review decisions into the medical bill review process

And to make sure the program best suits your unique needs, like many of our programs, medical bill review services can be integrated with other products, such as PPO and specialty networks or provided on a stand-alone basis.

Case Management

Starting with the first report of injury, our case management program, which includes telephonic, field and vocational assessments, establishes a claimant advocate who coordinates and channels care, where permitted, with accessible and experienced network providers. This helps to make certain medical treatment is:

  • Managed proactively based on recognized medical guidelines and evidence-based medicine
  • Safe, cost-effective and designed to promote recovery
  • In accordance with program parameters and jurisdictional regulations
  • Compassionate and well-coordinated to alleviate concerns and promote adherence
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