EDC ANALYZER

The goal of the Optum Emergency Department Claim (EDC) Analyzer is to achieve fair and consistent evaluation and management coding and reimbursement of facility outpatient emergency department claims. The EDC Analyzer™ systematically evaluates each ED visit level code in the context of other claim data (i.e., diagnosis codes, procedure codes, patient age, and patient sex*) to ensure that it reasonably relates to the intensity of hospital resource utilization as required per CMS Guidelines. Optum is committed to simplifying the health care system promoting transparency in the coding and reimbursement process. For more background information about the EDC Analyzer™, click here... Determines the standard weight of the visit based on the patient's demographic characteristics and presenting problem. Assigns a standard weight to the visit based on this evaluation.