October 21, 2025

Optum reinvents claims and reimbursement process to eliminate complexity and administrative waste

First-of-its kind innovation connects payers and providers in real-time delivering transparency and operational efficiency

(Oct. 21, 2025) – Optum is fixing one of the most costly and complex parts of health care—the claims and reimbursement process—with Optum Real, a real-time claims system that delivers instant coverage validation and improved claims.

By integrating responsible, AI-powered clinical and financial capabilities at every step of the claims and reimbursement journey, Optum Real helps providers know instantly what’s covered, payers receive more complete comprehensive claims based on unique member benefits, and patients gain greater transparency into their coverage and benefits before leaving the doctor's office.

“Imagine health care with the ease and clarity of other consumer like experiences where patients know their coverage and benefits in real-time, and claim issues are resolved at the point of care. That’s the future we’re building with Optum Real,” said Sandeep Dadlani, CEO of Optum Insight.

Connecting payers and providers in real-time
For decades, the claims process has been inefficient. U.S. hospitals spend nearly $20 billion annually to overturn claims yet 84% of first-time denials are avoidable. Complex rules, manual workflows, and fragmented systems across both payers and providers have contributed to administrative overhead and confusion for patients.

Optum Real changes that. This multi-payer platform allows real-time data exchange between payers and providers, enabling the identification and interception of known issues at the point of claim submission. UnitedHealthcare is the first health plan in the country to adopt this technology, expanding real-time transparency into adjudication to give members and providers instant clarity.

“This technology changes the game for providers and the members we’re privileged to serve,” said Tim Noel, CEO of UnitedHealthcare. “Optum Real transforms the pre-service experience in real time by delivering greater clarity and certainty to every interaction. That means providers and patients can spend less time navigating logistics and more time focused on delivering and receiving care.” 

Allina Health, a health system serving 12 hospitals and more than 90 clinics across Minnesota and western Wisconsin, is piloting Optum Real for outpatient radiology and cardiology and has already seen fewer administrative errors and improved patient experiences across more than 5,000 processed visits.

“Seeing issues prevented before they even happen has been incredibly rewarding,” said Dave Ingham, DO, CIO of Allina Health. “It’s not just about operational efficiency—it’s about giving patients a smoother experience from the start.”

Accelerating innovation at speed and scale
Payers are often constrained by outdated systems and unstructured data. Each payer has its own set of rules embedded in benefits and contracts that can vary by provider and patient. These rules often live in static documents that require manual processing. Optum Real addresses this complexity by applying human-centered AI and automation to analyze large volumes of contracts and data, surfacing relevant information so payers and providers can make faster, more accurate decisions. A recent study shows AI solutions and automation can save $150 to $300 billion in administrative costs alone.

With 20 years of deep health care expertise and AI-first innovation, Optum is transforming these static assets into a dynamic system that enables instant data exchange and accelerated claims adjudication.

Building the future of health care
Optum is setting a new standard for how health care operates—ushering in an efficient and connected system. Optum Real will be featured at HLTH 2025, where the company will share how ambient intelligence and real-time data are reshaping health care delivery and finance.