Upgrade to an on-premise, AI-powered partner
Optum360® offers physician advisor expertise, evidence-based medical research and sophisticated technology to support appropriate reimbursement and accurate quality reporting within your organization. We team up with your physicians to pinpoint improvement opportunities.
Our on-site and remote services can apply artificial intelligence to drive timely patient-status determinations. We deliver greater efficiency, accuracy and integrity to your utilization review and clinical documentation improvement processes and outcomes.
Our Physician Advisor Services can help you reduce denial rates, manage appeals, minimize audit risk and optimize reimbursement. They can also relieve the administrative burden on physicians, freeing them to devote more time to patient care.
Improve your acceptance rate
Our medical necessity recommendations acceptance rate is 91%*
Use evidence-based guidelines
20,000+ medical research articles back up recommendations
Tap 20+ years of experience
We’ve conducted 13M+ medical necessity reviews
Maximizing peer-to-peer denial appeals
Peer-to-peer reviews with payer medical directors were a challenge for Uniontown Hospital. Listen to how Uniontown Hospital was able to leverage the Optum360 On-Site Physician Advisor program to dramatically improve their peer-to-peer success rate.
Using a hybrid physician advisor program
Central Florida Health Alliance tried to insource its second-level medical necessity review process, but it was more challenging than anticipated. Hear how Saad Ehtisham, chief operating officer, turned to Optum360 On-Site Physician Advisors for their admission review needs.
* For dates Jan-April 2018. Assuming cases that were not appealed by Optum were all billed and accepted as Optum recommended.