Help ensure eligibility and benefits information is accurate
Drive claim accuracy with a network that includes more than 2,400 payer connections.
Our broad connectivity facilitates the exchange of up-to-date information to drive time and cost efficiencies and help support accurate, accelerated reimbursement.
We offer multiple options to improve the submission, processing and tracking of claims and attachments.
Our productized APIs are easy to implement and scale, giving you fast access to functionality spanning patient and member engagement, eligibility and claims processing, and data and interoperability management.
Explore our solutions
Software
EDI Network
Leverage our vast nationwide payer network to enable swift and secure sharing of information between providers, payers and patients.
Software
Smart EDI
Our advanced transaction management and routing services help you manage complex EDI workflows and reduce costly denials.
Service
Optum AI Marketplace
Your destination for healthcare innovation. Explore, test and purchase software APIs and services designed to solve real challenges and improve outcomes. Connect with trusted partners and discover solutions that turn breakthrough technology into meaningful impact.
Software
Hosted Payer Services
Integrated technology helps lower costs of maintaining high-availability systems needed to support dental and medical providers and members.
API-first revenue cycle integration
Available through the Optum AI Marketplace, these RESTful APIs support real-time, near real-time and batch transactions for eligibility, claims, attachments, prior authorization and remittance.
They use JSON to simplify EDI workflows, integrate with practice management systems or custom applications and connect to most U.S. payers.
A sandbox environment is available for testing functionality without the need for legacy infrastructure.
Industry insights
Article
Discover how real-time eligibility, benefits and claim status inquiries can improve accuracy and efficiencies for payers and providers.
Report
Discover 5 key trends that can help healthcare organizations streamline processes, minimize errors and deliver faster, more reliable services.
White paper
Discover how the final shift to electronic transactions can save billions and transform healthcare operations.