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Focused Claims Review

Ensure billing accuracy of professional claims.

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Cost savings found in the details

Focused Claims Review (FCR) is an innovative payment integrity approach targeting procedure and surgery claims. Complex claim errors can only be caught by physician reviewers with the clinical experience to spot mistakes that automated systems can’t detect.

Focused Claims Review Professional

Focused Claims Review Professional targets procedural and surgical claims with the greatest potential yield and a discrete number of providers with atypical billing patterns. 60 to 75 percent of targeted claims reviewed show errors, saving clients 16 to 24% of total claims dollars reviewed.1

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Incremental

Defined savings not found by automated programs

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Targeted

Minimum claims reviewed for maximum savings yield

Sustainable

Always refining targets saves long-term costs

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  1. Optum analysis – FCR Facility commercial and Medicare Advantage book of business, 2021-2022. *Individual plan results will vary.