LAS VEGAS, Nev.—Optum is rolling out a new, artificial-intelligence-powered system that aims to make the claims processing experience work more efficiently.
The company unveiled Optum Real as part of the 2025 HLTH conference Tuesday. The platform leans on Al for both clinical and financial support at each step of the claims and reimbursement process, letting providers know in real time what's covered and ensuring payers receive more complete claims data that account for an individual's unique benefits.
Optum is piloting Real with its sister health insurer UnitedHealthcare on the payer side as well as with Allina Health, a health system operating 12 hospitals across Minnesota and Wisconsin, for outpatient radiology and cardiology claims. Allina has seen a reduction in administrative errors under the pilot as well as a better patient experience in the more than 5,000 visits processed so far.
Dave Ingham, chief information officer at Allina Health, said in an interview that the Optum Real platform gets at some of the most burdensome administrative hurdles for its teams, while patients struggle with potential delays or denials.
"AI technology really has taken us to the next level, or at least given us vision of what that next level is—to get as real time as possible," Ingham said.
On the health plan side, the Optum Real platform enables data exchange in real time between payers and providers, making it easier to find issues at the moment a claim is submitted. This drives greater transparency into the claims management process for both providers and patients, per the announcement.
Puneet Maheshwari, senior vice president at Optum and general manager of Optum Real, told Fierce that getting partners like UnitedHealthcare and Allina on board is critical to making tech platforms like this work and that the team is already seeing further interest within hours of announcing the launch.
UnitedHealthcare's size and scale, in particular, helps generate "an upward vortex that can create the momentum that's needed to be created in the ecosystem" around a launch like this, he said. And getting buy-in from a health system like Allina makes for a critical proof point.
"When you start seeing the impact, now you have a flywheel that's revving up," Maheshwari said.
Ingham said the Allina team is now looking at other service lines where it could expand the technology, such as for surgical procedures. The health system is also watching with interest to see whether and when other health insurers sign on to deploy Optum Real.
For Maheshwari, he said that UnitedHealth Group, the parent company of both UnitedHealthcare and Optum, is committed to this shift, and, now, it'll take other stakeholders coming to the table. Optum is also looking to stay ahead of the curve on technology, leaning on partners across the spectrum from small startups to far larger players.
"Those two things combined is what's needed [and] is the recipe for success," Maheshwari said.