The CIO’s role in payment accuracy
CIOs are agents of change:• Enabling payment accuracy success by connecting
analytics, technology and operations • Empowering data scientists with needed tools
and access• Engaging with fellow C-Suite partners to provide
the right technology
CONSUMER
VP INFORMATICS
CHIEF EXECUTIVE OFFICER
CHIEF MEDICAL OFFICER
CHIEF COMPLIANCE OFFICER
CHIEF INFORMATION SECURITY OFFICER
CHIEF STRATEGY OFFICER
CHIEF FINANCIALOFFICERVP CLAIMS
CHIEF MARKETINGOFFICER
CHIEF OPERATIONSOFFICER CIO
CIOs play a pivotal role in successful payment accuracy
WHAT ARE THE SAVINGS POSSIBILITIES?
OPTUM BREAKS IT DOWN BY THE NUMBERS
WHAT SAVINGS ARE YOU MISSING OUT ON?
1 in 5 medical claims submitted are processed incorrectly
Up to $15.5 billion in unnecessary
administrative costs could be saved
by payers if insurance companies would
improve their claims processing accuracy.7
A loss of $6 per claim
That’s the cost to payers with
1 million members to reprocess a
claim.6 What percentage of your
claims require reprocessing?
3–7% inaccurately paid claims
Between 3 percent and 7 percent of
health care claims are inaccurately
paid, with reasons ranging from
mistakes to intentional fraud.5
Administrative cost savings up to
$47 billionBy using predictive modeling to pre-score claims for
coordination of benefits, upcoding, subrogation, fraud
and medical management prior to payment.9
$362 billionannually in medical cost savings
If payment integrity efforts were improved
and overpayments decreased through a
comprehensive payment integrity strategy.8
Payment accuracy is the low risk, high speed on-ramp to modernization
Administrative and medical expense savings possible with a comprehensive payment integrity strategy.
The savings realized can be utilized to fund system-wide modernization initiatives.
These savings can be achieved through:
$272+ million saved and recovered with a comprehensive payment integrity strategy4
$4 billion in annual savings recovered3
70% reduction in UR admin cost savings2
$158 millionsavings with a prepay strategy1
Adopting a cloud-based infrastructure
Integrating disparate data
Breaking down silos across the claims life cycle
1
2
3
Payment accuracy is at the intersection of analytics, operations and technology. A modern API, cloud-first strategy makes it possible to enhance value at the lowest price point. How is your organization implementing data and analytics into their payment integrity strategy?
Payment accuracy gives CIOs an opportunity to self-fund transformation.Explore our viewpoint by visiting optum.com/CIOLibrary
Sources
1. Optum observed client experience.2. Optum observed client experience.3. Optum observed client experience.4. Optum observed client experience.
5. Optum observed client experience.6. Optum observed client experience.7. Stern A. U.S. doctors say 1 in 5 insurance claims mishandled.
Reuters; June 14, 2010.
8. UnitedHealth Group. Health care cost containment. UnitedHealth Center for Health Reform & Modernization Working Paper 2; 2009.
9. Dorn C, Choffin M. Proactive payment integrity is a strategic investment. Optum white paper; 2013.
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