Compliance Checking

Demonstrate compliance and achieve accuracy in Medicare billing

Optum™ Compliance Checking promotes compliance with all guidelines from the Centers for Medicare and Medicaid and Office of Inspector General, and supports accurate and proper documentation for appropriate reimbursement.

Get more thorough pre-service checking

Optum Compliance Checking verifies medical necessity for Medicare Parts A and B outpatient services prior to service, imports chargemaster and other information, and identifies primary procedure based on CCI edit rules for each patient encounter.

Likewise, it provides real-time updates to provider and patient data, including demographic and diagnosis-related information, to save you key strokes and time.

By checking medical necessity prior to providing services, Compliance Checking helps you efficiently achieve accurate Medicare billing information and regulatory compliance.

Key benefits:
  • Improves Medicare compliance
  • Decreases risk of potential fines for billing non-covered services to Medicare
  • Clarifies patient rights and obligations prior to service
  • Reduces bad debt, denials and unnecessary write-offs

We’re ready to put our platform to work for you. Let’s start the conversation.
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For information about an Optum360 solution for your business please complete the form below. To speak with us sooner call 1-866-223-4730 or email Optum360@optum.com.

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An Optum professional will contact you shortly. To speak with us sooner call 1-866-223-4730 or email Optum360@optum.com.