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.

11000 Optum Circle, Eden Prairie, MN 55344

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