One platform. One partner. One integrated solution.
The category doesn’t need more point solutions in payment integrity. Health plans need end-to-end visibility across the entire claim lifecycle, so nothing slips through. The Optum difference is proactive prevention that helps stop issues upstream and improve accuracy over time.
All in on the future of payment integrity
By unifying solutions across the claim lifecycle, we help you catch issues earlier, act with greater precision and stay ahead of what's next.
End-to-end solutions and expertise
You get a coordinated, yet modular system that helps prevent errors earlier, pay claims more accurately and improve over time.
Solving problems before they even begin
Focusing upstream helps prevent errors before money moves. That means fewer incorrect payments, fewer appeals, fewer recoveries and less administrative rework.
Driving what’s next
Advanced analytics surface emerging risk, automation helps streamline review and machine learning sharpens precision over time. The outcome is speed, accuracy and sustained performance at scale.
Payment Integrity solutions
With a full suite of services and software that work together, and on their own, we're helping catch and prevent costly errors.
Solution suite
Cost Avoidance of Healthcare Claim Denials
Identify common healthcare billing errors and help prevent claim denials in real time.
Software
Claim Pricing solutions
Improve the accuracy and efficiency of your prospective payment system pricing.
Software
Claims Edit System
Achieve clean claims and maximize medical spend savings with our flexible, real-time claim editing software.
Solution suite
Fraud and abuse detection in healthcare claims
Stop suspicious activity before healthcare claims are ever paid with upstream fraud detection solutions.
Service
Claim Review
Prevent improper payments, reduce medical spend and minimize provider abrasion with our comprehensive suite of pre- and post-pay solutions.
Service
Coordination of Benefits
Identify and validate primary policy coverage with accurate eligibility data.
Service
Credit Balance Resolution Services
We help health plans identify, research and resolve overpaid claims.
Frequently asked questions about payment integrity
Payment integrity refers to the processes, technologies and controls health plans use to verify healthcare claims are paid accurately, appropriately and in compliance with regulatory and contractual requirements. It spans pre-submission, pre‑payment and post‑payment activities and includes verifying eligibility, confirming correct coding and billing, applying the right benefits and pricing, and detecting or preventing fraud, waste and abuse.
Mature payment integrity programs use advanced analytics and AI to help identify errors early, reduce overpayments and underpayments and streamline review workflows. Payment integrity is essential because it directly supports affordability, operational efficiency, compliance and stronger provider relationships by ensuring that financial resources are used correctly and claims are adjudicated with accuracy and transparency.
Learn the best practices that are helping health plans optimize their payment integrity services.
Healthcare payment integrity is crucial for health plans because it verifies claims are paid accurately and appropriately, which directly impacts affordability, compliance and operational efficiency.
By leveraging advanced payment integrity software and payment integrity services, health plans can help maximize savings and improve administrative efficiency.
Ultimately, payment integrity in healthcare safeguards financial resources and enhances the value of care delivered to members.
Payment integrity in healthcare helps improve accuracy by using advanced analytics and AI to detect errors, fraud and waste in claims and support correct claims payments.
Payment integrity also helps reduce overpayments, which leads to measurable savings for health plans.
Integrated, scalable payment integrity solutions deliver the highest ROI for health plans by unifying claim review processes and catching errors before payment.
Discover proven payment integrity tips that generate savings quickly.
The future of payment integrity is payment precision. With payment precision, the potential for increased payment accuracy is found at claim submission by shifting traditional payment integrity interventions into the provider workflow.
Rather than addressing coding and billing errors post-submission through denials and offsets, health plans and providers will be able to better identify errors at the source, reducing the need for costly corrections and rework.
Payment precision leads to higher accuracy, reduced administrative burden and improved collaboration with providers — ultimately contributing to a more affordable and transparent health care system for everyone.
Find out how health plans are partnering with healthcare payment integrity vendors to pivot toward payment precision.
With its abilities to automate and analyze, AI has a major impact on payment integrity in healthcare. AI is being used to automate claims review, detect errors and fraud, and improve accuracy throughout the claim lifecycle.
Payment integrity solutions with advanced AI models analyze vast amounts of claims data in real time to help identify patterns, flag anomalies and prioritize high-risk claims for further review.
Technologies like predictive analytics and natural language processing (NLP) help spot suspicious billing behaviors, automate coding and documentation checks and streamline repetitive tasks.
By shifting interventions upstream — catching errors before payments are made — AI reduces manual effort and enables health plans to optimize costs and operational efficiency.
Health plans can reduce provider abrasion by emphasizing collaborative education, transparent communication and minimizing administrative burdens associated with claim denials and appeals. Payment integrity solutions enabled with AI and analytics can help eliminate common pain points.
Discover strategies to create a payment integrity program that works well for both health plans and providers.
Healthcare payment integrity trends
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Discover the five levels of maturity and practical tips to strengthen your plan's performance.
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Medical costs are rising, and health plans need solutions. See how an AI-driven, enterprise-wide approach may be the key to affordability.
![5 AI Use Cases in Payment Integrity [White Paper]](/content/dam/optum-dam/images/business/insights/man-sitting-at-desk-using-computer-1080x720.jpg)
White paper
A strategic blueprint to modernize your payment integrity program through intelligent, AI-driven health plan operations.