Claims Processing
AMA wants Optum to stop its approach for recouping loans and to suspend all claim filing deadlines.
Starting Jan. 1, 2026, payers must send prior authorization decisions within 7 days and expedited decisions within 72 hours.
Letter to CEO Andrew Witty follows report of DOJ launching investigation into the company's billing methods.
The plaintiffs have accused the insurer of using artificial intelligence algorithms to illegally deny claims.
Initiatives include adding new concierge teams to support customers experiencing challenges with claims payments.
Reasons include prior authorization or referral, excluded services and administrative issues, KFF finds.
The figure of 190 million people has been amended from past estimates, which put the total at about 100 million.
Mayo alleges that Sanford in South Dakota is responsible for $739,956.20 in medical expenses incurred by a patient in 2022.
AI automates the process of reading insurance card images and addresses potential claim denials in real time.
The proposed rule would need to become final under the Trump Administration.