A healthcare payment system that works better for everyone
Healthcare claim processing is complex, time-consuming and often frustrating. Payers and providers must navigate legacy technology, complex rules and unclear regulations, and a lack of effective interoperability between payer and provider systems. These challenges lead to significant inefficiencies like unnecessary errors, lack of transparency, untimely delays and abrasion between payers, providers and patients.
Both payers and providers end up spending unnecessary time and money on administrative tasks and rework instead of focusing on patients and their care. Powered by AI and automation, Optum Real is facilitating real-time interoperability between payers and providers to help make the health system work better for everyone.
Transforming claim processing
With real-time exchange of patient visit, claim and payment data between payers and providers, Optum Real gives providers insight into how payers will process a claim when they need it — from pre-service to payment.
It also leverages ambient AI to capture the patient-provider encounter and autogenerate notes directly in the provider’s existing workflow. Our Clinical Language Intelligence engine uses AI to identify gaps and provide intelligent recommendations, helping reduce provider burnout, minimize administrative costs and improve documentation and coding accuracy.
Available on the Optum AI Marketplace
Real-time APIs for eligibility, claims and benefits
Subscribe to the Optum Real APIs to enable real-time exchange of eligibility, claim and benefit data with payers through a single integration. This suite of APIs can help providers to:
- Submit real-time eligibility inquiries
- Pre-check claims before care is delivered
- Receive instant claim status updates
- Validate patient benefits and prior authorization and referral requirements before care is delivered
- Submit more accurate claims, reconsideration requests, appeals and supporting documentation
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