Optum Credit Balance Recovery


Credit balances occur when a hospital’s total reimbursement exceeds the appropriate amount. These overpayments exist for a number of reasons and can be difficult and time-consuming to uncover. They’re often the result of claims processing complications at the hospital level such as:

  • Claims that were covered by auto accident medical or workers’ compensation insurance and also billed to the health insurance by the provider;
  • Incorrect charges due to multiple billings and duplicate payments;
  • Payment in excess of the allowed amount for an identified covered service.

Optum uncovers and recovers credit balances at provider facilities nationwide for AEPC participating groups.

They are the industry leader in health care overpayment recoveries, based on total dollars collected with more than $11 billion in overpayments recovered since 2000. Optum has more than 450 regional account managers (RAMs) on site at hospitals across the country. Optum also provides hospitals with feedback and process improvement opportunities.

Optum is paid a percentage of savings on each claim where there is a recovery – so there is no fee to AEPC participating groups until there is a recovery. There are no implementation and/or ongoing fees. Optum provides statements and recovered dollars monthly directly to the AEPC group.

Click here to see Optum’s Fact Sheet on Multi-tiered recovery services.

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