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Solve coding challenges with OPTUM online coding tools

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Optum is your source for top industry coding, billing and reimbursement solutions. We are a leading health services business with more than 30 years of industry experience.

Optum online coding tools make work a little easier. Always up to date with the proper code sets, our online coding tools help you spend less time searching for that elusive code, researching compliance rules and codes, or digging for referential information.

Our online coding tools support various solution areas:

Web-based Coding, Billing and Reimbursement

EncoderPro.com: Physician-based coding, compliance and reimbursement for commercial, Medicare and CMS-1500 reporting
Download EncoderPro.com Flyer
EncoderPro.com for Payers: Comprehensive coding, billing and reimbursement resource to meet the specific needs of health insurance companies, self-insured employers and third-party administrators
Download EncoderPro.com for Payers Flyer
RevenueCyclePro.com: Facility-based coding, compliance and reimbursement content and tools related to commercial, Medicare and UB-04 reporting
Download RevenueCyclePro.com Flyer
ASCExpert.com: ASC-based coding, compliance and reimbursement for commercial, Medicare and UB-04/CMS-1500 reporting
Download ASCExpert.com Flyer
Add-on Content: Specialized add-on content to customize your subscription

Fee and Chargemaster Maintenance

Enterprise ChargemasterExpert.com: Automated chargemaster review and maintenance tool
Download Enterprise ChargemasterExpert.com Flyer
FeeAnalyzer.com: Relative and actual physician charge data by location and specialty
Download FeeAnalyzer.com Flyer
Add-on Content: Specialized add-on content to customize your subscription

Medicare and Drug Reference

DrugReimbursement.com: Searchable FDA drug-specific coding and reimbursement referential database
Download DrugReimbursement.com Flyer
MedicalReferenceEngine.com: Searchable Medicare, Medicaid policy and coding guidelines database
Download MedicalReferenceEngine.com Flyer
Add-on Content: Specialized add-on content to customize your subscription

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Agreement

You must accept the license agreement before downloading any Optum, LLC Product(s)

LICENSE AGREEMENT

PLEASE READ THIS AGREEMENT CAREFULLY. THIS IS AN AGREEMENT BETWEEN YOU AND Optum, LLC. IF YOU DO NOT AGREE WITH THESE TERMS, DECLINE WHERE INSTRUCTED, AND YOU WILL NOT BE ABLE TO ACCESS OR USE THESE FILES. You are referred to below as "Customer".

LICENSE.

Optum hereby grants to Customer a nonexclusive, nontransferable license to access and use the files and data contained in this product (the â€œProduct(s)â€), within the United States as contemplated in the accompanying documentation and for Customer's internal, lawful, business use, and to the extent Customer has paid the applicable fees for such access and use. Customer acquires no other rights to the Product(s).. Customer shall ensure that anyone with authorized access to Optum Product(s) will comply with the provisions of this Agreement.

USE OF PRODUCT.

Customer agrees to hold the Product, in strict confidence and agrees not to provide, disclose or otherwise make available any of such to any third party. Customer shall have no right to allow any person or entity that is not an employee or consultant of Customer to access the Product, directly or indirectly in any way. Customer shall ensure that anyone without authorized access to Optum Products will comply with the provisions of this Agreement. Customer shall not publish, translate or transfer possession of the Product or create derivative works based on the Product. Customer shall not distribute the Product to any site or allow any site to load the Product into its computer system without identifying the site to Optum and paying the applicable fees. Customer may not sublicense, assign, or transfer this license, the Product, or the output produced by the Product to any third party Customer shall not disclose, allow disclosure of, or sublicense the Product to any third party or allow any third party access to or use the Product. Customer shall not reproduce the Product contained therein on any public electronic information system or public electronic bulletin board, including but not limited to the Internet. This provision shall survive the termination of this License Agreement. Customer shall not remove copyright notices from the Product.

ACCURACY AND ERRORS.

Customer agrees that Optum and its employees and agents shall not be held responsible or liable for any actions taken by Customer, or any error, inaccuracy, or omission in any report or analysis Customer prepares in connection with or through use of the Product, or for any damage (including, but not limited to consequential damages) resulting from it. No later than thirty days from the date of Customerâ€™s receipt of access to the Product or any update of the Product, Customer shall advise Optum in writing of any known errors or suspected errors that may materially affect the Product.

DISCLAIMER OF WARRANTIES.

Optum warrants that the Product performs in accordance with the documentation for it. To the extent that the Product contains information Optum has received from third parties, Optum warrants only that the Product contains an accurate copy of the information that was delivered to Optum. Except as expressly provided in this Agreement, OPTUM MAKES NO WARRANTIES OR REPRESENTATIONS RELATING TO THE PRODUCT EXPRESS OR IMPLIED, AND SPECIFICALLY DISCLAIMS THE WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE

LIMITS ON LIABILITY.

In no event will Optum be liable to Customer for any damages, including any lost profits, lost savings or any indirect, incidental, special, consequential or punitive damages arising out of the use or inability to use the Product(s) even if Optum has been advised of the possibility of such damages, or for any claim by any third party. However, in the event that a court with jurisdiction determines that Optum is liable for damages under this License Agreement, Optum's liability shall not exceed the greater of the price Customer paid for use of the Product(s), or One Thousand Dollars ($1000). Under no circumstances will either party be responsible under this License Agreement for any indirect, incidental, special or consequential damages resulting from either partyâ€™s performance or failure to perform under this License Agreement, including, without limitation, the use of or inability to use the Product, any damage to equipment and any cost of recovering lost data or of reprogramming. PROTECTION. United States and international copyright laws protect the Product(s), the accompanying documentation, and the Product contents. Customer acknowledges that the Product(s) contain valuable assets, trade secrets, and/or copyrighted material of Optum, and that Optum and its licensors retain title to the Product(s) and all contents therein.

CPT CODES.

Current Procedural Terminology ("CPT") codes, descriptions, and two-digit modifiers maintained in the Product(s), CPTÂ® Assistant and CPTÂ® Changes are copyrighted by the AMA and CPT is a registered trademark of the AMA. Optum grants Customer a nontransferable, nonexclusive license to use CPT codes, for the sole purpose of internal use by Customer within the United States, as part of the Product(s). Optum's ability to deliver updated versions of CPT to Customer is dependent upon continuing contractual relations with the AMA.

The AMA provides CPT "AS IS", without any liability to the AMA, including, without limitation, no liability for consequential or special damages or lost profits for sequence, accuracy or completeness of the CPT data. The AMA does not warrant that CPT will meet Customer's requirements. The AMA disclaims any liability for any consequences due to use, misuse or interpretation of information contained or not contained in CPT. The AMAâ€™s sole responsibility is to make available to Optum replacement copies of the CPT codes if the CPT codes are not intact. AMA disclaims any liability for any consequences due to use, misuse, or interpretation of information contained or not contained in CPT codes.

In the event the Product(s) include NTIS material, the responsibility for the content of any "National Correct Coding Policy" included in the Product(s) is with the Centers for Medicare and Medicaid Services ("CMS") and no endorsement by the AMA is intended or should be implied.

Customer may only make copies of the CPT codes in the Product(s) for back up or archival purposes. All notices of proprietary rights, including trademark and copyright notices, must appear on all permitted back up or archival copies made. Customer may print or download CPTÂ® Assistant and/or CPTÂ® Changes CPT codes from the Product(s) solely for its own internal use, without any modification to the content, and in such a way that the appropriate citation is included.

In the event Customer is a health plan, health insurer or similar entity or an administrator thereof , Customer shall complete and provide to Optum a completed AMA Health Plan Worksheet annually and upon the request of Optum. Customer warrants and represents that it will submit the Health Plan Worksheet with completeness and accuracy. The following definitions apply: (i) â€œMemberâ€ means an individual with coverage under any health plan that is not a Medicare Fee for Service (or â€œTraditional Medicareâ€) plan. This includes individuals enrolled in plans where the health plan is providing Administrative Services Only (â€œASOâ€); and(ii)â€œSystems Arrayâ€ means a category of electronic products used to perform key functions in health plan operations and is determined using the Health Plan Worksheet.

CDT CODES.

The terms of this Section apply to the extent that the Product(s) contain CDT codes. Customer acknowledges and agrees that the American Dental Association owns all right, title and interest (including all copyrights and other intellectual property rights) in the CDT codes (in all print and machine readable forms), all other rights of commercialization, rental or sale of the CDT or any part thereof, the right to make derivatives of the CDT and the right to distribute the CDT and copies thereof. Customer acquires no proprietary interest in the CDT, or any portion thereof. Except for the limited rights expressly granted to Customer herein this Agreement, all other rights in the CDT are owned and retained by ADA. Customer agrees to indemnify ADA (including reasonable attorneys' fees and costs of litigation) against and hold ADA harmless from any and all claims, liability, losses, damages and expenses resulting from Customer's use of the CDT, in breach of any of the terms of this Agreement, or Customer's use of any data or documentation received from ADA, regardless of the form of action.

AHA NOTICE.

Copyright 2018, American Hospital Association (â€œAHAâ€), Chicago, Illinois. Reproduced with permission. No portion of this publication may be reproduced, sorted in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior express, written consent of AHA. The following applies to the extent that the Product(s) contain content licensed to Optum by the American Hospital Association (â€œAHA Contentâ€):

The Company's right to provide the Licensed Content to the Customer in connection with the Company Product(s) pursuant to the Customer Agreement is dependent upon the continuation of the contractual relationship between Company and Health Forum. If this contractual relationship expires or is otherwise terminated, the Customer Agreement will be immediately terminated and the Customer will be required to discontinue all use of the Licensed Content pursuant to this Agreement. Customer will not contest or challenge (or assist others to so do) AHAâ€™s rights with respect to the AHA Content.

If Customer is a United States federal government agency, the following applies:

ICD-9-CM Coding Clinic.

This product contains AHA CODING CLINICÂ® FOR ICD-9- CM content which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Hospital Association, 155 N. Wacker Dr., Suite 400, Chicago, Illinois 60606. U.S. government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-l(a) (June 1995) and DFARS 227.7202-J(a) (June 1995), as applicable, for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (December 2007) and/or subject to the restricted rights provisions of FAR 52.227-14 (December 2007) and FAR 52.227-19 (December 2007), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

HCPCS CODING CLINIC.

This product contains AHA CODING CLINICÂ® FOR HCPCS content which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Hospital Association ("AHA"), 155 N. Wacker Dr., Suite 400, Chicago, Illinois 60606. U.S. government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-J(a) (June 1995), as applicable, for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (December 2007) and/or subject to the restricted rights provisions of FAR 52.227-14 (December 2007) and FAR 52.227-19 (December 2007), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

UB-04 Manual.

This product contains OFFICIAL UB-04 DATA SPECIFICATIONS MANUAL, content which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Hospital Association ("AHA"), 155 N. Wacker Dr., Suite 400, Chicago, Illinois 60606. U.S. government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable, for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (December 2007) and/or subject to the restricted rights provisions of FAR 52.227-14 (December 2007) and FAR 52.227-19 (December 2007), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

AHA provides the AHA Content â€œAS ISâ€ and expressly disclaims all warranties, conditions, representations, indemnities and guarantees, whether express or implied, arising by law, custom or prior oral or written statements, with respect to the AHA Content (including, but not limited to, any warranty of satisfactory quality, merchantability, fitness for a particular purpose, title and non-infringement, accuracy timeliness, and completeness) to the maximum extent allowed by law. AHA further disclaims, and shall have no liability for, any errors, omissions or inaccuracies in the AHA Content or any uses, misuses or interpretations of the information contained in or not contained in the AHA Content. AHA also does not warranty that the AHA Content will be accessible in any particular hardware/software environment. Customer shall be solely responsible for the use, efficient, and suitability of the AHA Content.

In no event will AHA be liable for any indirect, special, or consequential (including lost profits), exemplary or punitive damages arising out of or related to this Agreement, or performance or breach of this Agreement, even if it has been advised of the possibility of such damages. AHAâ€™s liabilities under this Agreement, if any, shall in no event exceed the sum of the fees actually received by Optum in connection with this Agreement for the applicable AHA Content.

U.S. Government Rights

This product includes CPT and/or CPTÂ® Assistant and/or CPTÂ® Changes, which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60654. U.S. government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable, for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (December 2007) and/or subject to the restricted rights provisions of FAR 52.227-14 (December 2007) and FAR 52.227-19 (December 2007), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements

GENERAL PROVISIONS.

Customer agrees that Optum may terminate Customer's access to the Product(s) and this Agreement at any time if Optum reasonably believes that Customer is in violation of this Agreement. This Agreement shall automatically terminate if Customer fails to comply with any provision of this Agreement. Customer acknowledges that Customer has read this Agreement, understands it and agrees to be bound by its terms and conditions. Customer further agrees that this is the complete agreement between Customer and Optum and that this Agreement supersedes any proposal or prior agreement, oral or written, and any other communications between Customer and Optum relating to the subject matter of this Agreement. Upon termination of this Agreement, Customer will cease using the Product(s) and return the Product(s) to Optum. In the event a provision of this Customer Agreement is determined to violate any law or is unenforceable, the remainder of the Customer Agreement will remain in full force and effect.

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