we specialize in solutions for the Maritime industry to control medical costs
As a leading end-to-end payment integrity organization, Optum specializes in solutions for the domestic and international Maritime industry to control medical costs. Our proprietary solutions provide payers and consumers with assurance that their medical costs are true, accurate, and reasonable.
The Maritime industry faces challenges dealing with crewmembers' hospital and provider bills reflecting huge markups and the need for oversight and review. Optum works closely with
P&I Clubs, Vessel Owners, Cruise Lines, Vessel Agents, and Brokers and Port Agents to
negotiate their crewmembers' medical bills – all while achieving the highest possible savings
for the Maritime payer.
We are also experts in handling crew medical care, which is governed under Admiralty Law and the Jones Act, and requires specialized processes in the design of the overall workflow and coordination.
Clients requiring a broader spectrum of customized payment integrity solutions utilize the Optum Bill Review services. Optum Bill Review services are tailored solutions for our specialized markets and include the following service options:
Bill Audit includes reviews for appropriateness, integrity and validity such as correct coding, medical necessity, usual and customary charge review, pre-existing condition analysis, coordination of benefits/third-party liability and recovery, repatriation considerations, and coordinated review with client’s in-house medical review or contracted medical case review.
Medical Case Review
Optum employs contracted physicians and registered nurses to consult with clients regarding the effectiveness of a covered person’s treatment. Our network of board-certified physicians and registered nurses provides consultation and support related to implementing cutting-edge cost containment and quality management strategies currently being used within the health care industry. Medical management services include prospective, concurrent and retrospective review, pre-certification, emergency room review, and utilization management reporting.
After a claim has been case reviewed and audited, Optum staff utilize all of the data to renegotiate the claim based on the audit and case review findings.
We have established ourselves as a national leader in superior payment integrity and medical management services. Our ideas are innovative, our solutions are results oriented, and our procedures are technologically superior.
What Makes Us Different?
- Customer-focused company
- Dedicated regional Account Managers
- Ability to cater to multiple workflow expectations
- Committed quality assurance professionals
Repricing is the recalculation of billed medical charges based on the rates and rules a PPO has negotiated through its provider agreements. Optum Maritime manages the complexities of administration and data maintenance with over 40 PPO networks and connected payers throughout the world. We partner with claims payers to relieve the administrative burden inherent with repricing management through the following services:
Primary Network Services
We provide “single source access” to over 40 of the leading primary PPO networks. In addition to network access for medical services, we provide access to a selection of specialty networks designed to deliver savings for specific services such as lab, dental, DME, and other healthcare services.
For charges that are not repriced through a network, Optum offers services to negotiate a discounted price on a payer’s behalf after the service has been rendered. Negotiation is the last step in the process of driving overall savings and every effort is made to achieve the best possible savings for the client. Our motto is “NO SAVINGS, NO FEE!”
Optum offers appointment scheduling services for Maritime clients, including cruise lines and vessel owners. The primary function of this administrative service is to secure the next available appointment within the requested specialty for the injured crewmember. Our appointment scheduling specialists:
- Can arrange specialty visits in the majority of U.S. ports
- Are careful to observe any directions given by the medical service provider(s)
- Coordinate with the vessel captains, ship managers, and port agents