1. See the EncoderPro.com Difference
Leaders are leaders for a reason. Understanding how EncoderPro.com provides unparalleled coding information and claims review is your key to accuracy and financial return.

2. Presentation disclaimer
While the information provided in this presentation is believed to be reliable, Optum360® is providing this information for educational purposes only and not as a replacement for professional judgment and experience. Therefore, any use of this information is at your sole risk, and Optum360 neither assumes nor is responsible for its use and does not make any representation or warranty regarding the content of this presentation.

3. In this presentation we will discuss…
– An overview of speed-to-content – Optum360 proprietary content and unparalleled access to content from such organizations like the AMA, AHA, CMS and many other coding organizations – Access to industry-leading code/claim review tools that can review commercial payer claims, Medicare claims, and even state-level Medicaid claims prior to submittal

4. The EncoderPro.com difference summarized
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The EncoderPro.com difference summarized 1
Faster searching of content you search every day … code book indexes, coding guidelines, LCD policies, etc. 2
Faster and more complete access to AMA, AHA, CMS and other content from organizations you trust. 3
Coding compliance review that goes well beyond CCI and LCD. A coding tool that checks commercial, Medicare, and even state-level Medicaid claim edits. 4
Sourcing to code-to-modifier relationships, coding rules and appeals/claim denial support. 5
No longer just a “nice-to-have.”
© 2016 Optum, Inc. All rights reserved.

5. More efficient access to coding content

6. Content overview: And this is just the beginning…
Features include, but not limited to:
CodeLogic™ Search Engine
Color Code Edits (over 30 icon alerts per code type)
Lay descriptions/annotations
Deleted Code Crosswalk
Real-time updates
User Notes and favorite lists
Print Code Summary
All code book resources (indexes, tables, appendixes, notes, guidelines)
ICD-9-CM V1, V3, HCPCS and Anesthesia Crosswalks
Medicare’s Pub 100
Modifier Crosswalk
Future codes
QPP (MIPS) per code
CMS/commercial HCC information
Medicare CCI (Correct Coding Initiative) edits
MPFS Fee Calculator (with reductions)
LCD/NCD policy look-up tools
A complete claims review Tool (Compliance Editor — Powered by Optum® Claims Manager)
Merck Manual content (NEW!)

7. Speed to code — Code search tools and indexes
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Only Optum:
CodeLogic™ code searching and code book index searching for increased efficiency from documentation to code:
© 2016 Optum, Inc. All rights reserved.

8. Access to guidelines — Print products on steroids
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Only Optum:
Code ranges to truly see codes as they appear in a print book (for accuracy) and fast access to related content:
© 2016 Optum, Inc. All rights reserved.

9. Access to guidelines — Print products made easier
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Only Optum:
Coding guidelines arranged by chapter, section, range and code (pioneered by Optum360):
© 2016 Optum, Inc. All rights reserved.

10. Powerful claims review for commercial, Medicare and state-level Medicaid coding guidelines

11. Optum360 claims review The EncoderPro.com Compliance Editor difference
Why?
The years of claims review rules experience
The high volume of edit rules
Complete sourcing to each edit
Simply put, Optum360 claims review goes well above and beyond just the standard claims review.

12. Optum360 claims review

13. Optum360 claims review

14. Optum360 claims review — Commercial payer edits
EncoderPro.com contains edits that are common across all commercial payers, and coding rules that apply to a commercial payer setting from several sources.
As a result, commercial edits also can be applied to Medicare and Medicaid, as they may be related to general coding guidelines and “line of business” may not apply. (Does not contain specific commercial payer edits.)

15. Optum360 claims review — Medicare edits
Medicare edits can be national or specific to the Medicare Administrative Carrier (MAC) selected. As commercial payers often use Medicare as their initial source for claim adjudication, users can benefit from checking commercial claims using the Medicare line of business as well.

16. Optum360 claims review — State-specific Medicaid edits
Both national- and state-level Medicaid edits (number of state-level edits varies by state) are provided, with new state edits being added frequently. While there are 77 Medicaid edits, there can be several permutations of state-specific exceptions to each rule, thus providing potentially many more edits, as each state has different guidelines and exceptions to standard edits.

17. Physician Web-based Solution Product Manager
Contact Information
Ryan Devey
Physician Web-based Solution Product Manager