Sales Demo Prototype

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  • Sounds good. But I don’t want to take too long. How quickly can you get us results and where do we start?
  • If you like what you see, we can look at your claims data and tell you the type of savings you could realize with our Comprehensive Payment Integrity –OR- FWA solution.
  • We can accept your submission via secure FTP or upload via our portal. Data is secure and can only be accessed by your account's analysts and whomever you identify.
  • We have three different claims systems, four different enrollment systems, and two provider contract databases. Each type has slightly different data structures and data is collected and updated on different schedules. Will this be a problem?
  • We can use your data as is and transform it so we can get the outcomes you’re seeking.
  • 48 hours later...
  • From January to September, our retrospective FWA analysis identified 124 providers submitting claims in an aberrant pattern. We verified which would qualify as fraud, waste, or abuse; this represents over $3.8M in claim overpayments.
  • Since we had all the data we needed to run our Subrogation module, we identified 1300 instances where you paid a claim when you did not have primary responsibility. This potentially represents over $4.3M in overpayments.
  • Very interesting. Can you explain how you arrived at these results?
  • Setting: Client site Background: Client has invited Optum for RFP presentation. Product functionality demonstration is complete and Proof of Concept is being discussed. Actors: Optum Sales Consultant and Client Process Owner
  • Setting: Client site Actors: Optum Intake Representative and Client IT Rep
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