Optum Launches AI-Driven Claims Processing Tool
Introduction of Optum Real
On Tuesday, Optum introduced an innovative artificial intelligence-backed system named Optum Real, designed to enhance and streamline the medical claims and reimbursement process. This tool enables healthcare providers to communicate effectively and obtain real-time information regarding patients’ health benefits.
Aims and Benefits of Optum Real
Optum claims that this new tool could significantly reduce claims denials and offer patients greater transparency regarding their coverage. Puneet Maheshwari, general manager of Optum Real, emphasized the advantages of this system during the HLTH 2025 conference in Las Vegas, stating, “The provider doesn’t have to guess. They can ask the payer in real time. So it’s not two weeks after when somebody is doing the coding of the chart.”
Insights on Healthcare Claims Processing
Challenges in the Current System
Healthcare organizations spend billions each year managing financial transactions, including claims processing, prior authorization requests, and bill collections. Often, patients lack clarity about their coverage and the costs associated with their care, frequently receiving bills for services weeks after they are rendered. Experts believe that AI has the potential to address these issues effectively.
The Role of AI in the Healthcare Sector
The topic of AI has taken center stage at this year’s HLTH conference, with discussions revolving around its potential to alleviate workforce challenges and reduce the administrative burden on healthcare providers. However, Maheshwari cautioned that if payers and providers adopt competing AI solutions for claims submission and review, the healthcare industry may not resolve the prolonged process. “Today, it’s my rule-based system against your rule-based system,” he noted. “Tomorrow, it’s going to be my AI versus your AI.”
Functionality of Optum Real
Real-Time Data Exchange
Optum Real is designed to facilitate real-time data exchange between insurers and providers, enabling them to identify potential errors or issues at the time of claim submission and to validate coverage immediately. According to a press release from Optum, the tool utilizes AI to analyze payer contracts and guidelines, allowing both providers and insurers to make quicker decisions regarding claims.
Adoption and Testing
UnitedHealthcare, the health insurance division of Optum’s parent company, UnitedHealth, is the first health plan to implement this technology. Additionally, Allina Health, which operates 12 hospitals and over 90 clinics in Minnesota and western Wisconsin, is currently testing the tool in areas such as radiology and cardiology. So far, Optum Real has successfully assisted in processing over 5,000 patient visits.