Diagnosis-related group (DRG) outlier
For a Blues plan, Optum clinical staff found antifungal agents billed at 10 times the recommended dosage. This saved our client more than $200,000, nearly 85% of the billed charges.
Itemized Bill Review
Our targeted clinical and financial review leverages Centers for Medicare and Medicaid Services (CMS) and clean-claim evaluation to review inpatient facility claims. We work in concert with our clients’ provider relations team, which minimizes provider abrasion.
Related resources
Case study 2: High-dollar claim savings
DRG outlier identified, resulting in $600,000 savings.
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