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Coding and documentation for payer-provider connectivity

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Optum360 offers physician advisor expertise, evidence-based medical research and sophisticated artificial intelligence (AI) technology to support appropriate reimbursement and accurate documentation.

We team up with your physicians to pinpoint improvement opportunities. Choose from services, technology or a combination of both to fit your needs.

Our on-site and remote services can apply AI to drive timely patient-status determinations. We deliver greater efficiency, accuracy and integrity to your utilization review process and outcomes.

Our Physician Advisor Services and our Case Advisor™ technology can help you reduce denial rates, improve appropriate reimbursement and minimize audit risk. Our technology can help your internally sourced physician advisors become more effective and efficient.

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Improve your acceptance rate

Our medical necessity recommendations acceptance rate is 91%*

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Use evidence-based guidelines

20,000+ medical research articles back up recommendations

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Tap 20+ years of experience

We’ve conducted 14M+ medical necessity reviews

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Revolutionizing utilization review with artificial intelligence

Traditional utilization review (UR) processes can be slow and error-prone. Learn how Optum360 is leveraging the power of AI to revolutionize UR for greater efficiency, accuracy, and more appropriate use of clinical resources.

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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.

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Start the conversation

The path to a denial-free future is possible with the right partner. Our flexible engagement model can adjust to match your organizational needs.

Contact us online

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* For dates Jan-April 2018. Assuming cases that were not appealed by Optum were all billed and accepted as Optum recommended.