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About Us

Optima is a Healthcare Management System that improves beneficiary relations and health outcomes, and be proactive in the management of the plan operations.

Optima enables Medicare Advantage (MA-PD) and Accountable Care Organizations (ACO) health plans of all sizes reduce administrative overhead, improve beneficiary relations and health outcomes, and be proactive in the management of the plan operations.

Optima provides the software and services to streamline and strengthen core business processes in today’s challenging, competitive, and changing managed care industry.

Healthcare is a complicated business. With moving parts and changing rules, we create Optima that not only keep you on the forefront, but also improve your productivity. Whether you need a tool to better manage your growing population, optimize your Medicare revenue or edit claims more efficiently.

why optima infographic

Optima supports the following functions:

ACCOUNTABLE CARE

Improve your patient outcomes with our clinical, financial and performance-based suite of solutions.

BENEFIT DESIGN

Identify and wellness issues, utilization trends, demographics and other risk factors impacting your populations.

BUDGETING & UNDERWRITING

Improve quality and costs through medical management, budgeting and underwriting and performance measurement.

CLAIMS EDITING

Eliminate waste and inefficiencies with a real-time engine which leverages predictive analytics.

ENTERPRISE & ACCOUNT REPORTING

Uncover opportunities to boost results, demonstrate performance and facilitate administrative reporting processes.

FACILITY BILL ANALYSIS & NEGOTIATION

Employ innovative technology to detect fraudulent claims and rely on experts to successfully negotiate your bills.

FRAUD, WASTE & ABUSE

Detect new and emerging FWA schemes with our breakthrough technology and improve your payment accuracy.

MEDICAL COST MANAGEMENT

Identify and target wasteful and fraudulent schemes and implement utilization management controls.

MEDICAL RECORD RETRIEVAL & REVIEW

Employ expert clinician coders for audit, documentation, coding and quality assurance measures.

MEDICARE ADV. REVENUE OPTIMIZATION

Leverage our end-to-end solutions for all issues relevant to the reconciliation and payment of Medicare and Medicaid.

NETWORK MANAGEMENT

Leverage your data to compare practice and physician level efficiency associated with admission rates.

POPULATION HEALTH MANAGEMENT

Organize and define cohorts of members across the risk spectrum and integrate them into operational workflows.

PROGRAM & VENDOR MANAGEMENT

Evaluate cost, utilization and condition prevalence trends to ensure you spend your resources wisely.

QUALITY & COMPLIANCE

Manage the health of patients with chronic diseases to contain medical costs and improve care quality.

RISK CONTRACT MANAGEMENT

Drive network, medical and population health management activities to improve risk-based contracts.

RECORD RETRIEVAL FOR LIFE & LEGAL

Customized record retrieval and workflow to meet the demands of life insurance and legal services providers.

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