Optum Real system
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Hospital Group Says UnitedHealth AI System Reduces Claims Denials
PYMNTS.comยท 2025-10-21 14:48
Core Insights - An artificial intelligence system from UnitedHealth Group has significantly improved prior authorization requests and reduced medical claims denials during testing at Allina Health [1][2] - The Optum Real system, developed by UnitedHealth's Optum Insight unit, flags claims needing more documentation, thus streamlining the medical claims process [2][3] - UnitedHealth Group aims to expand the system's reach by connecting more insurance providers and reducing transaction costs [3][4] Group 1: System Functionality and Impact - The Optum Real system has meaningfully reduced claim denials by identifying claims that require additional documentation before submission [2] - The AI system has alleviated the disappointment associated with claim denials and minimized paperwork for healthcare providers [2][6] - UnitedHealth Group has reported having 1,000 AI applications in production across various business segments, including insurance and health delivery [4][5] Group 2: Business Model and Future Plans - Optum Insight does not charge fees for connecting companies to the system's core functions, instead focusing on monetizing through digitization and advanced analytics [4] - The company has emphasized the importance of digital technology in reducing administrative tasks and enhancing customer experience [5][6] - A report indicated that 44% of healthcare executives have AI agents in production, with many allocating over 50% of future AI budgets to these agents [7] Group 3: Investment and Returns - A significant majority (90%) of healthcare executives reported positive returns on previous investments in generative AI [8]