1. Maximize Administrative Savings with an Enterprise Payment Integrity Strategy

2. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 2 Erin Schmuker, Director, Optum Director of client operations, leads delivery of Optum payment integrity solutions for payers. Over 15 years of experience in health care payment integrity operations and business development, with 10 years focused on helping payers and providers implement pre- and post-payment integrity programs to drive efficiency and savings. Works with clients to identify opportunities to implement best practices for payment integrity across the enterprise.

3. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 3 Today’s topics 1.Payment integrity pressures ― market factors 2.Administrative cost reduction opportunities 3.Recommended best practices 4.Case studies 5.Q&A

4. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 4 Payment integrity pressures Who’s the first payer? Increasing Membership Flux Public and private exchanges Commercial or Medicare or Medicaid Increasing Membership Flux Public and private exchanges Commercial or Medicare or Medicaid Membership Why are we manually reworking the claim? Payment Responsibility Creates provider and member friction and increased appeals and grievances with increased call volumes High cost rework for claims Payment Responsibility Creates provider and member friction and increased appeals and grievances with increased call volumes High cost rework for claims Payments When should it be paid? Regulatory Mandates Prompt pay guidelines: federal and state ICD-10 compliance −Impact on reimbursement −Opportunity for fraud, waste and abuse Regulatory Mandates Prompt pay guidelines: federal and state ICD-10 compliance −Impact on reimbursement −Opportunity for fraud, waste and abuse Regulatory

5. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 5 Room for improvement

6. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 6 Major drivers of claims errors Core Claims Process Intake and prep Provider contracts and networks Benefits Authorizations Post-Adjudication Provider contracts and networks Enrollment and eligibility System Selection and Implementation People, Process and Technology Check eligibility Determine benefits Price claim Check auths Remit payment Intake and prep Select provider

7. Payment Integrity Best Practices

8. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 8 Regular self-assessment Benefits Annual cadence provide comparison across claims processing Ability to see trends and implement changes to improve specific areas Establishes baseline set of KPIs Benefits Annual cadence provide comparison across claims processing Ability to see trends and implement changes to improve specific areas Establishes baseline set of KPIs Identify gaps across the claims processing environment Compare to best practices ‒ Industry and internal Identify gaps across the claims processing environment Compare to best practices ‒ Industry and internal Regular basis Review results Monitor KPIs Effectiveness Implement changes

9. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 9 Take proactive prepayment approach Benefits Avoids pay and chase resulting in cost savings Productivity gains Benefits Avoids pay and chase resulting in cost savings Productivity gains Apply pre-payment methodologies such as prospective payment/ pricing, claims editing Clean claims Prospective payment Claims editing Prospective FWA

10. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 10 Intelligent, integrated analytics and reporting Benefits Quickly identify problems across enterprise Make changes to reduce financial leakage Provides executives with concise, accurate data and KPIs Benefits Quickly identify problems across enterprise Make changes to reduce financial leakage Provides executives with concise, accurate data and KPIs Create enterprise viewpoint with unified reporting across claims processing Health plan payment integrity enterprise reporting Prepayment Post payment Claims editing Pricing/ groupers Credit balance Fraud, waste, abuse Subrogation

11. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 11 Employ electronic payments Benefits Meets regulatory requirements Lowers administrative costs Enhances reporting/audit trail for reimbursements Improves provider relationships with faster, more accurate reimbursements Benefits Meets regulatory requirements Lowers administrative costs Enhances reporting/audit trail for reimbursements Improves provider relationships with faster, more accurate reimbursements Employ electronic payments and statements (EFT/ERA and / or virtual card payments) $0.50 ‒ $1.50: Average cost of mailing a check or explanation of benefits $486,000 per year: Amount a payer could save on printing, paper and postage costs if it paid 80% of claims via an EFT/ERA system (assumes payer has 750,000 covered members, 9 million claims per year and 46,875 network providers) 20% ‒ 50% decrease: Typical decrease payers have in claims payment administration costs by using an integrated data and payment solution

12. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 12 Root cause analysis Benefits Eliminates the root cause Drives down costs Increases accuracy Benefits Eliminates the root cause Drives down costs Increases accuracy Use internal and external partners to identify root cause and establish strategic framework

13. Payment Integrity Case Studies

14. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 14 Case study: Major drivers of claims errors from the claims audit Optum conducted a claims audit from a root cause analysis perspective for a regional health plan. Designated number of randomly selected claims associated with suspected problem areas were reviewed. Error reasons categorized as follows:

15. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 15 Case study: Prepayment claims editing A regional health plan sought a single claims editing solution for both professional and facility claims. Requirements: ‒ Easily integrate with their adjudication system ‒ Automate and customize editing without involving IT staff Situation Selected a claim editing solution that processed both claim types, with a seamless interface to their adjudication system and custom rules. Non-IT staff can build their own custom-rules, cutting down on IT staff support. Seamless integration to their adjudication system allows for complete transparency between the two systems. Solution Streamlined operations, reduced manual processes, and improved productivity. $30 million in savings over three years due to ability to uncover services or procedures that should not have been reimbursed. Results

16. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 16 Key take-aways Payment integrity impacts: Membership flux Payment issues Regulatory mandates Best practices: Assessment Prepayment approach Analytics Electronic payments Root cause analysis Payment integrity impacts: Membership flux Payment issues Regulatory mandates Best practices: Assessment Prepayment approach Analytics Electronic payments Root cause analysis Take Advantage of the Enterprise Approach Lower costs Improve accuracy +

17. Thank you! Questions: erin.schmuker@optum.com