Optum
Optum is the leading health services and innovation company providing comprehensive revenue cycle management, claims processing, and healthcare technology solutions. Integrated with AdvancedCare, Optum delivers enterprise-grade claims management, payment integrity, and data analytics trusted by healthcare organizations nationwide to optimize financial performance and improve operational efficiency.
Enterprise Leader
Part of UnitedHealth Group, serving healthcare systems and organizations globally
Comprehensive Solutions
End-to-end revenue cycle from claims to collections with integrated analytics
Revenue Excellence
Proven strategies and technology increase collections and reduce denials
Key Features
Advanced Claims Management
Optum's revenue cycle solutions provide comprehensive claims management from submission through payment. Intelligent claim scrubbing uses machine learning to identify and correct errors before submission, significantly reducing denial rates. Electronic submission to all major payers ensures fast delivery and processing. Automated claim status tracking provides real-time visibility into each claim's progress. The platform handles complex billing scenarios including Medicare, Medicaid, commercial insurance, and workers' compensation. Advanced coding support ensures accurate CPT, ICD-10, and HCPCS code selection with built-in validation.
Payment Integrity & Optimization
Optum's payment integrity solutions ensure every claim is paid correctly and completely. Pre-payment claim edits catch billing errors before submission. Post-payment audits identify underpayments and contractual variances. The system automatically reconciles payments against expected reimbursement based on fee schedules and contracts. Denial management workflows automate appeals with payer-specific documentation requirements. Contract management tools ensure accurate reimbursement rates are applied. Analytics identify patterns in denials, underpayments, and payer performance to drive continuous improvement.
Data Analytics & Business Intelligence
Optum leverages healthcare's largest data repository to provide actionable insights that optimize revenue cycle performance. Benchmarking compares your practice against peers to identify improvement opportunities. Predictive analytics forecast revenue, identify at-risk accounts, and recommend interventions. Real-time dashboards track KPIs including days in A/R, collection rates, denial rates, and clean claim percentages. Custom reporting enables deep analysis of specific metrics or workflows. The platform's AI capabilities continuously learn from billions of claims to improve accuracy and efficiency over time.
Platform Capabilities
Clearinghouse Services
Submit claims to all major payers with direct EDI connections and tracking
Eligibility Verification
Real-time insurance verification with benefits and coverage details
Denial Management
Automated denial categorization, appeals, and root cause analysis
Payment Posting
Automated ERA/EOB processing with payment matching and reconciliation
Advanced Analytics
Comprehensive reporting on revenue cycle metrics with predictive insights
Managed Services
Optional outsourced RCM services with dedicated billing specialists