Strategies for Improving Bill Review Savings

This white paper discusses the importance of optimized medical bill review in managed care, particularly in the context of reducing costly billing errors. It outlines the Clinical & Coding Logic (CCL) solution introduced by Optum in 2017, designed to enhance existing medical bill review processes. The document explains how CCL supplements current auditing efforts by utilizing advanced technology to identify coding errors that may be overlooked. It details the components of the CCL solution, including the AuditPoint platform, complex bill review rules, and a team of clinical professionals. The paper emphasizes that CCL integrates seamlessly with existing systems, providing additional savings without implementation costs. Furthermore, it highlights the role of the CCL team in ensuring compliance with current guidelines and improving payment integrity. An example from California illustrates the potential savings achieved through the CCL review process, demonstrating its effectiveness in the workers' compensation and auto industries.