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
EDI Network Leverage our vast nationwide payer network to enable swift and secure sharing of information between providers, payers and patients.
Software
Payer Connectivity Services
Our claims system for payers and TPAs consolidates transaction streams at a single point to manage administration, routing and adjudication.
Service
Optum AI Marketplace
Visit our marketplace to learn about our scalable, flexible APIs. From eligibility checks and claim submissions to real-time status updates, our APIs provide a robust, secure and compliant framework that integrates into your existing systems.
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
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Streamline the implementation process of healthcare lab operations and enhance enrollment control with our self-service tool.
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Streamline workflow and increase accuracy with Clinical Exchange ePrescribe and Surescripts Real-Time Prescription Benefits.
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Healthcare systems need new systems to better facilitate enrollment despite staffing shortfalls.