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Focused Claims Review Cost-Savings Program Now Available For Self-Funded Customers

March 7, 2017

The Focused Claims Review program has proven itself to be a money saving feature for UnitedHealthcare’s fully insured customers, and it is now being extended to our self-funded customers.

The program is a unique post-service pre-payment claims verification program that helps generate cost-savings by auditing claims to find billing errors that cannot be identified by computer based claim editing programs and other automated claims processing. The program goes beyond standard bill and claim audit capabilities leveraging board-certified physicians that compare selected physician claims with surgical notes; identifying and preventing payment of submitted claims that do not describe the services actually rendered.

The Focused Claims Review program applies to claims that are orthopedic and other procedural-based services (e.g. cardiology, neurosurgery, podiatry, otorhinolaryngology or ears, nose, throat (ENT), urology and dermatology).

Program Highlights

  • Most overpayments occur when claims are submitted with codes that do not match the description of services rendered; automated tools do not compare procedure codes to surgical/procedural notes.
  • This program enhances the work of existing Payment Integrity Programs by utilizing board-certified physicians to review like-specialty claims.
  • The Focused Claims Review program is able to identify errors prior to release of a payment or explanation of benefit (EOB). 

For additional information, please reference the Focused Claims Review program brochure or contact your UnitedHealthcare representative.