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The National Labor Alliance of Health Care Coalitions works with its member coalitions and its Product Development committee to form strategic partnerships and alliances with organizations which provide advantages in service, quality and cost to participating funds. The NLAHCC works with experts to conduct RFIs which provide a due diligence for participating funds. The methodology and results are shared with member coalitions. (See our Member Entrance section.)

image Produts and Services Overview Optum logo

Overview

Since 1999, Optum and the NLA have worked together to provide credit balance and payment integrity solutions to member funds. Our long-term relationship allows Optum to develop and deliver comprehensive services tailored for 125 member funds.

Services Offered:

Credit Balance Resolution Service
You have a system to identify overpayments—but what if something is missed? Even a few recurring errors can cost your organization. With Credit Balance Resolution service from Optum, we help research and resolve inventory of credit balance accounts that can cost funds. Our solution supplements NLA initiatives and delivers information that enables funds to better recover overpayments, prevent recurring errors and provide actionable reporting.

Our Credit Balance Resolution service provides on-site and remote location professionals to identify the procedural and system issues that cannot be seen without access to provider data.

  • Optum uncovers and resolves credit balances at more than 1,700 provider facilities nationwide.
  • Our reviews routinely uncover opportunities to prevent future overpayments.
  • Optum provides confidential, quarterly benchmarking summaries that compare a payer’s performance against industry standards.

Optum’s detailed root-cause error documentation helps NLA funds to collaborate with providers to discontinue processes that lead to ongoing errors and resolve outstanding credit balance accounts to positively influence fund costs.

Payment Integrity
Funds are faced with unprecedented internal and external challenges that make efficient claims management a necessity. Optum understands these challenges and offers NLA funds a comprehensive set of prospective and retrospective solutions that can help strengthen the payment cycle to achieve accurate transactions that improve relationships and reduce costs.

In collaboration with the NLA, Optum provides extensive expertise, rich data resources and innovative analytics tools that build on funds’ knowledge of their enterprises and membership to deliver a fresh perspective on their business.

This holistic approach allows Optum to help NLA funds:

  • Identify and recover inappropriate claim payments and overpayments
  • Simplify and reduce the administrative cost of the payment cycle
  • Avoid and prevent inappropriate claim payments and overpayments

Optum’s comprehensive payment integrity solutions and flexible approach provide NLA funds a competitive advantage as well as a proven return on the investment in the technology and services.

Quality and Savings:

Using the Optum services provides quality results and savings. Optum works with each Coalition and does not go directly to the funds. Funds who are currently using Optum should go to their local Coalition to receive this preferred rate.

The Optum contract is available to member coalitions

See the Member Entrance section

Primary Contact

Nick Ridings
Phone: 615.503.1261
Email: nicholas.ridings@optum.com

 
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