Determine appropriate ED visit coding and billing levels
Find out how Optum® Emergency Department Claim (EDC) Analyzer — Facility helps health plans determine fair and consistent levels of facility reimbursement for outpatient emergency department (ED) services.
EDC Analyzer applies standard cost factors with extended cost factors and patient complexity costs to determine the appropriate ED visit level.
Consistent and defensible application of CMS guidelines
With no national standard methodology for applying ED visit-level coding, inaccurate billing can occur. EDC Analyzer — Facility was developed around 11 general guidelines for outpatient facility coding levels published by the Centers for Medicare & Medicaid Services (CMS).
With a uniform and consistent review of submitted emergency department coding, EDC Analyzer — Facility can help deliver an accurate ED visit-level calculation.
![Team reviewing data on computer](/content/dam/o4-dam/images/professionals/health-plans/team-reviewing-data-on-computer-content-block-1.jpg)
![Woman analyzing data](/content/dam/o4-dam/images/professionals/health-plans/woman-analyzing-data-content-block-2.jpg)
Reduce medical spend through accurate claim payment
After recommending the appropriate visit level, EDC Analyzer — Facility can automatically reprice claims to help ensure fair facility reimbursement for ED services rendered. This saves health plans an estimated $3-9 PMPY (per member, per year).