Unmatched Services for Comprehensive Healthcare Interoperability
At the core of the Optum Medical Network are its robust clearinghouse services. These services facilitate all standard healthcare administrative transactions, including 837P, 837I, 837D, 835, 275, 278, 270/271, 276/277, 834, and acknowledgment transactions like 277CA and 999. The Optum clearinghouse efficiently manages millions of medical and dental providers through SFTP, APIs, and portals, while supporting thousands of payers via real-time and API connections. Harness a network that offers unparalleled connectivity, support, stability, and security at scale.
Modernizing the claims process for everyone
Accelerate transaction processing with secure cloud-based solutions
- Enable swift, accurate and secure claims and remittance transmission via direct connections.
- Minimize delays with intelligent alerts and dashboards for proactive issue resolution.
- Help to improve first pass rates with behind-the-scenes edits and customizations.
Reduce processing cost-per-claim through automation
- Identify the most efficient path for claims to be delivered to the final claim adjudicator.
- Enhance accuracy by validating and normalizing data.
- Support supplemental data needs and facilitate PPO repricing.
- Automate workflows with personalized pre-adjudication rules.
Improve claims accuracy and help support timely, appropriate care
- Get real-time eligibility verification for providers, payers and administrators.
- Improve claim accuracy and streamline authorizations.
- Ensure regulatory compliance, including HIPAA and CORE, with our ENHAC-certified clearinghouse.
- Access our secure network of 2,400 payers.
Send and receive electronic claims attachments to drive efficiency
- Submit the correct documentation the first time by accessing payer-specific requirements.
- Help reduce customer-service calls with visibility into claim and attachment status.
- Lower the administrative burden and costs of paper workflows.
Key benefits
Our secure solutions are designed to drive accuracy, improve efficiency and reduce costs.
Built to support your business
Leverage multiple options to streamline eligibility verification and the submission, processing, and tracking of claims and attachments.
Use APIs to access our network
Our productized APIs are easy to implement and scale, giving you fast access to advanced functionality available with our solutions.
Help ensure accuracy of eligibility and benefits
Our broad connectivity facilitates the secure exchange of information to drive time and cost efficiencies, and support accelerated reimbursement.
Gain connectivity, flexibility and innovation
Our EDI Network offers smarter transaction processing and advanced interoperability with healthcare networks nationwide.
Let’s start a conversation
We’re here to help you find out how our services could benefit your organization.
Our experts will:
- Discuss your individual use case and business needs
- Explain our features, benefits, and services
- Show how this solution can help achieve your goals
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