Optum Settlement Solutions
Optum was the first workers’ compensation company to integrate Medicare Set-Aside (MSA) services into a comprehensive portfolio of pharmacy and medical services programs. We continue to innovate to meet the evolving needs for Medicare Secondary Payer (MSP) compliance regulations in workers’ compensation and liability settlements. Applying the industry’s deepest knowledge bank of pharmacy, medical, claims, and legal expertise, we consistently deliver proven solutions for cost containment.
Through our dedicated Government Affairs team, we maintain a strong and active regulatory presence, keeping a constant pulse on legislative developments in all 50 states and address compliance requirements real time to deliver insightful solutions for critical business issues. We actively work as an advocate for our clients to ensure that requirements are met and appropriately applied. Optum’s Government Affairs team is at the forefront of guiding policies that protect the interests of our clients and their injured workers. Over the years, Optum has cultivated long-term relationships with CMS, state government agencies, regulatory officials and key legislators—allowing for regular communication about pending regulation/legislation—and the opportunity to effect meaningful change for the industry.
Optum’s Settlement Solutions division is a premier provider of MSA allocations and a leader in MSP compliance education, preparation and programs. Our focus involves providing innovative services that help drive down settlement costs while maintaining regulatory compliance. We are recognized as the industry-leading advocate on issues such as prescription allocations in MSAs that limit the ability of payers to achieve fair and equitable settlements and impede business productivity. From formulating medically based alternative methodologies for regulatory consideration to developing new solutions as industry needs unfold, we use our unique set of multi-disciplinary competencies to support understanding and communication across the industry.
Based on our extensive and long-standing experience in working with CMS, we are at the forefront of Mandatory Insurer Reporting (MIR) compliance, as required by Section 111 of the Medicare, Medicaid and SCHIP Extension Act (MMSEA) of 2007. By integrating our core competencies in MSAs, client connectivity, state reporting and information technology, Helios has created MedicareConnect℠, a comprehensive solution for MMSEA111 reporting that delivers a 95% acceptance rate on submissions to CMS. As the reporting process continues to mature, we deliver insights on the latest developments and direction from CMS to support industry-wide compliance.
Learn more about Optum Settlement Solutions.