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Focused Claims Review

Ensure the billing accuracy of professional claims. 

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Cost savings found in the details

Complex claim errors can only be caught by physician reviewers with the experience to spot mistakes that traditional automated systems can't detect. Focused Claims Review (FCR) is an innovative billing accuracy review approach targeting procedure, surgery and facility claims. 

 

  • A significant percent of targeted claims reviewed (55% to 65%) show errors.
  • Clients saved 17% to 22% of total claims dollars reviewed.*

Focused Claims Review Professional

Target procedural and surgical claims with the greatest potential yield and a discrete number of providers with atypical billing patterns. 

Incremental

FCR defines savings not found by automated programs.

Targeted

A minimum number of claims are reviewed for maximum savings yield.

Sustainable

Continually refined targeting improves savings over time.

Focused Claims Review Facility

This solution engages a broad range of clinical and analytical resources to help reduce facility claim costs in excess of $100,000 payable. 

Specialized

Only a select set of catastrophic facility claims are reviewed.

Targeted

Uphold rates average 97% due to partnership approach with facility.

Partnership

Expect comprehensive support from start to finish.

Let’s start a conversation

We’ll help you find out how our solution could benefit your organization. 

Get in touch with our sales team today

Fill out this form and we’ll get back to you shortly.

Already a customer? Find your support portal.

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*Savings represent cost reductions from the total claims dollars reviewed. Based on analyses including presale assessments and Optum performance metrics representing blended average experience across the program’s book of business 2023.