Photo: Courtesy of UnitedHealth Group
Optum has introduced Optum Real, a real-time AI claims system that offers faster reimbursement by connecting payers and providers in real time.
Optum Real provides instant coverage validation through AI-powered clinical and financial capabilities, Optum said.
Providers know instantly what’s covered, payers receive more complete comprehensive claims based on member benefits, and patients gain greater transparency into their coverage and benefits before leaving the doctor's office, Optum said.
Optum said Allina Health, a health system serving 12 hospitals and more than 90 clinics across Minnesota and western Wisconsin, is piloting Optum Real for outpatient radiology and cardiology. The health system has realized fewer administrative errors and improved patient experiences across more than 5,000 processed visits.
“Seeing issues prevented before they even happen has been incredibly rewarding,” said Dave Ingham, CIO of Allina Health. “It’s not just about operational efficiency – it’s about giving patients a smoother experience from the start.”
WHY THIS MATTERS
UnitedHealthcare said it is the first health plan to adopt the technology.
The multi-payer platform identifies and intercepts known issues at the point of claim submission. This avoids manual processes that add to the nearly $20 billion annually hospitals spend to overturn claims, according to Optum. An estimated 84% of first-time denials are avoidable.
“This technology changes the game for providers and the members we’re privileged to serve,” said Tim Noel, CEO of UnitedHealthcare.
Payers often have outdated systems and unstructured data, along with their own set of rules over benefits and contracts. These rules often live in static documents that require manual processing, Optum said.
Human-centered AI and automation can analyze large volumes of contracts and data, surfacing relevant information.
A March McKinsey study cited by Optum said AI solutions and automation can save $150 billion to $300 billion in administrative costs alone.
“Imagine healthcare with the ease and clarity of other consumer-like experiences where patients know their coverage and benefits in real time, and claim issues are resolved at the point of care. That’s the future we’re building with Optum Real,” said Sandeep Dadlani, CEO of Optum Insight.
THE LARGER TREND
In 2023, UnitedHealth Group's Optum bought Change Healthcare and its claims processing business for $13 billion.
In February 2024, a ransomware attack brought down the system, affecting hospital and physician payments and an estimated 190 million people.
In May 2024, then-CEO Andrew Witty admitted to House and Senate committees that UnitedHealth Group paid a $22 million ransom to help restore services and to protect patient information.
Email the writer: SMorse@himss.org