A/R Recovery and Denial Management

JSON twin: https://www.healthaidb.com/software/a-r-recovery-and-denial-management.json

Company Name

Optum

Product URL

https://www.optum.com/en/business/providers/health-systems/revenue-cycle-performance/reimbursement/ar-recovery-and-denial-management.html

Company URL

https://www.optum.com

Categories

• administrative Operations
• revenue Cycle
• billing
• managed Services
• health Data Analytics
• Administrative
• Revenue Cycle Management
• Claims Management
• Denial Management
• Analytics

Summary

Optum's A/R Recovery and Denial Management solution integrates managed services with advanced technology to reduce claim denials and accelerate accounts receivable recovery, enhancing revenue cycle performance for healthcare organizations.

Description

Optum's A/R Recovery and Denial Management combines specialized recovery teams with automation platforms like Payment Integrity Compass and Revenue Performance Advisor to streamline third-party billing, denial resolution, and A/R follow-up. The solution offers automated claim classification, batch processing, pre-populated appeal workflows, and detailed root-cause analytics to reduce denials and accelerate recovery across all payer types. Enhanced by robust contract modeling, real-time eligibility APIs, and dynamic reporting dashboards, it supports both day-to-day collections and complex events like revenue cycle system conversions or secondary claim backlogs.

Api Available

yes

Certifications

• FDA 510(k)
• CE/MDR
• ONC
• ISO 27001

Company Founding

2011

Company Offices

• United States
• Canada
• United Kingdom
• Australia
• Germany
• France
• Italy
• Spain
• Netherlands
• Sweden

Compliance

• HIPAA
• HITECH
• SOC 2

Customers

• OptumCare
• Optum Advisory Services
• OptumRx
• AdvancedMD
• Tebra
• TriZetto QNXT
• MicroMD PM
• Essentials
• Waystar
• RXNT
• Spyglass
• eClaimStatus
• CareMe Health
• Surest (Bind) Health Insurance

Data Residency

US and global deployment/managed options (contact vendor for region-specific hosting)

Data Standards

• FHIR
• HL7 v2
• X12 EDI (837/835)

Deployment Model

• SaaS
• managed_services
• hybrid

Features

• Claims denial identification and management
• Accounts receivable (A/R) recovery and backlog remediation
• Automated, configurable workflow for denial remediation
• Root cause analysis for denial prevention
• AI/ML-driven denial prediction (claims remittance analysis)
• Pre-populated appeal letter generation
• Analytics and actionable reporting (operational KPIs)
• Prioritization/triage of accounts and denials
• Supplemental/outsourced recovery staffing (HFMA-certified specialists)
• Integration into existing revenue cycle workflows
• 24/7/reduced turnaround operational support

Id

SW1203

Integration Partners

• AdvancedMD
• Tebra
• TriZetto QNXT
• MicroMD PM
• Essentials
• Waystar
• RXNT
• Spyglass
• eClaimStatus
• CareMe Health
• Surest (Bind) Health Insurance

Integrations

• Payment Integrity Compass
• Revenue Performance Advisor
• EHR and practice management systems
• Billing / clearinghouse / revenue cycle systems
• Payer remittance and eligibility feeds
• Optum Revenue Cycle APIs / Marketplace APIs
• Third-party billing vendors

Languages Supported

• English
• Spanish
• French
• German
• Italian
• Dutch
• Swedish
• Norwegian
• Danish
• Finnish
• Belgian Dutch
• Swiss German
• Austrian German
• Irish English
• New Zealand English
• Japanese
• Korean

Last Updated

2025-10-11

License

commercial

Market Segment

• enterprise
• smb

Optional Modules

• Denials prevention analytics
• Advanced predictive modeling for at-risk claims
• Custom reporting and dashboards
• Supplemental staffed recovery teams

Os Platforms

• Web

Pricing Details

Contact vendor for pricing information.

Pricing Model

subscription

Privacy Features

• Business Associate Agreement (BAA) available
• Data minimization and controlled access

Product Code

SW1203

Product Name

A/R Recovery and Denial Management

Ratings

• OptumCare: 3.9/5 (7 reviews) - G2
• Optum Advisory Services: 3.3/5 (17 reviews) - G2
• OptumCare: 3.4/5 (25 reviews) - G2

Regions Available

• United States
• Canada
• United Kingdom
• Australia
• Germany
• France
• Italy
• Spain
• Netherlands
• Sweden
• Norway
• Denmark
• Finland
• Belgium
• Switzerland
• Austria
• Ireland
• New Zealand
• Japan
• South Korea

Related Urls

• https://elion.health/products/optum-ar-and-denial-management

Release Year

2000

Security Features

• Encryption (in transit and at rest)
• Role-based access control (RBAC)
• SSO/SAML support
• Audit logging

Specialties

• Radiology
• Cardiology
• Orthopedics
• Neurology
• Oncology
• Pediatrics
• Dermatology
• Gastroenterology
• Pulmonology
• Urology
• Obstetrics
• Gynecology
• Emergency Medicine
• Anesthesiology
• Pathology
• Psychiatry
• Family Medicine
• Internal Medicine
• General Surgery
• Plastic Surgery

Support Channels

• email
• phone
• chat
• ticketing
• community
• 24x7

System Requirements

Target Users

• clinicians
• nurses
• admins
• payers

Training Options

• documentation
• webinars
• live_online
• onsite
• certification

Type

product

User Reviews

• Optum not the best. Any issue, project or task is so difficult with Optumcare because they outsource all of their workers overseas. This makes communicating very difficult. Only specific plans use on shore representatives, and that is if that company pays extra for that.
• Nothing. Any issue, project or task is so difficult with Optumcare because they outsource all of their workers overseas. This makes communicating very difficult. Only specific plans use on shore representatives, and that is if that company pays extra for that.
• NOTHING. There is nothing at all that I have come to find that I like with any optum product. Again support is very limited and anyone at any location has no clue as to what is going on and cannot advise anything to you when you are in need of help.
• Everything. I dislike the lack of communication amongst products. I wouldn't say I like the lack of communication for providers to seek help or even attempt to troubleshoot. You are forced to obtain their products. One section of the company never knows how to send you to the appropriate team for specifics, as everyone that you can get through can never help you. Again, this is all contributed to the language barrier for this company employing all overseas workers. Some of the appropriate departments you need to speak with do not have a way to communicate with them directly. All of this contributes to not having a good relationship with OptumCare. If you want to be contracted with United Healthcare then you are forced to get several Optum products and you have to sign up for each one.
• If you can avoid it then do but it is very difficult to avoid, especially if you want to be in network with United.
• User friendly, easy to navigate through and efficient.
• Layout, needs to be refreshed colors are boring.
• Optum Rx is Efficiency and Ease. I am closely associated with someone who has been using OptumRx for managing their prescription benefits, and overall, their experience has been positive. The convenience of their online platform for ordering refills and tracking shipments has made the prescription process more efficient. One of the standout features is the user-friendly website, which provides easy navigation to find medication details, order history, and cost information. The option to receive notifications about order status and shipping updates is a helpful addition, ensuring awareness of the status of prescriptions.
• However, like any service, there's always room for improvement. Occasionally, there were delays in processing and shipping, but these instances were infrequent and usually promptly resolved after contacting customer support.
• OptumRx solves the challenges of managing prescriptions by offering a centralized online platform. It streamlines the process of ordering refills, tracking shipments, and understanding medication costs. This convenience saves time, enhances cost transparency, and ensures timely fulfillment of prescriptions, contributing to improved medication adherence. Responsive customer service addresses inquiries promptly, making the overall prescription management experience efficient and user-friendly.

Version

1.0

Alternatives

See related products

Canonical JSON

{
  "product_name": "A/R Recovery and Denial Management",
  "company_name": "Optum",
  "product_url": "https://www.optum.com/en/business/providers/health-systems/revenue-cycle-performance/reimbursement/ar-recovery-and-denial-management.html",
  "company_url": "https://www.optum.com",
  "related_urls": [
    "https://elion.health/products/optum-ar-and-denial-management"
  ],
  "product_code": "SW1203",
  "summary": "Optum's A/R Recovery and Denial Management solution integrates managed services with advanced technology to reduce claim denials and accelerate accounts receivable recovery, enhancing revenue cycle performance for healthcare organizations.",
  "description": "Optum's A/R Recovery and Denial Management combines specialized recovery teams with automation platforms like Payment Integrity Compass and Revenue Performance Advisor to streamline third-party billing, denial resolution, and A/R follow-up. The solution offers automated claim classification, batch processing, pre-populated appeal workflows, and detailed root-cause analytics to reduce denials and accelerate recovery across all payer types. Enhanced by robust contract modeling, real-time eligibility APIs, and dynamic reporting dashboards, it supports both day-to-day collections and complex events like revenue cycle system conversions or secondary claim backlogs.",
  "categories": [
    "administrative Operations",
    "revenue Cycle",
    "billing",
    "managed Services",
    "health Data Analytics",
    "Administrative",
    "Revenue Cycle Management",
    "Billing",
    "Claims Management",
    "Denial Management",
    "Managed Services",
    "Analytics"
  ],
  "market_segment": [
    "enterprise",
    "smb"
  ],
  "target_users": [
    "clinicians",
    "nurses",
    "admins",
    "payers"
  ],
  "specialties": [
    "Radiology",
    "Cardiology",
    "Orthopedics",
    "Neurology",
    "Oncology",
    "Pediatrics",
    "Dermatology",
    "Gastroenterology",
    "Pulmonology",
    "Urology",
    "Obstetrics",
    "Gynecology",
    "Emergency Medicine",
    "Anesthesiology",
    "Pathology",
    "Psychiatry",
    "Family Medicine",
    "Internal Medicine",
    "General Surgery",
    "Plastic Surgery"
  ],
  "regions_available": [
    "United States",
    "Canada",
    "United Kingdom",
    "Australia",
    "Germany",
    "France",
    "Italy",
    "Spain",
    "Netherlands",
    "Sweden",
    "Norway",
    "Denmark",
    "Finland",
    "Belgium",
    "Switzerland",
    "Austria",
    "Ireland",
    "New Zealand",
    "Japan",
    "South Korea"
  ],
  "languages_supported": [
    "English",
    "Spanish",
    "French",
    "German",
    "Italian",
    "Dutch",
    "Swedish",
    "Norwegian",
    "Danish",
    "Finnish",
    "Belgian Dutch",
    "Swiss German",
    "Austrian German",
    "Irish English",
    "New Zealand English",
    "Japanese",
    "Korean"
  ],
  "pricing_model": "subscription",
  "pricing_details": "Contact vendor for pricing information.",
  "license": "commercial",
  "company_offices": [
    "United States",
    "Canada",
    "United Kingdom",
    "Australia",
    "Germany",
    "France",
    "Italy",
    "Spain",
    "Netherlands",
    "Sweden"
  ],
  "company_founding": "2011",
  "deployment_model": [
    "SaaS",
    "managed_services",
    "hybrid"
  ],
  "os_platforms": [
    "Web"
  ],
  "features": [
    "Claims denial identification and management",
    "Accounts receivable (A/R) recovery and backlog remediation",
    "Automated, configurable workflow for denial remediation",
    "Root cause analysis for denial prevention",
    "AI/ML-driven denial prediction (claims remittance analysis)",
    "Pre-populated appeal letter generation",
    "Analytics and actionable reporting (operational KPIs)",
    "Prioritization/triage of accounts and denials",
    "Supplemental/outsourced recovery staffing (HFMA-certified specialists)",
    "Integration into existing revenue cycle workflows",
    "24/7/reduced turnaround operational support"
  ],
  "optional_modules": [
    "Denials prevention analytics",
    "Advanced predictive modeling for at-risk claims",
    "Custom reporting and dashboards",
    "Supplemental staffed recovery teams"
  ],
  "integrations": [
    "Payment Integrity Compass",
    "Revenue Performance Advisor",
    "EHR and practice management systems",
    "Billing / clearinghouse / revenue cycle systems",
    "Payer remittance and eligibility feeds",
    "Optum Revenue Cycle APIs / Marketplace APIs",
    "Third-party billing vendors"
  ],
  "data_standards": [
    "FHIR",
    "HL7 v2",
    "X12 EDI (837/835)"
  ],
  "api_available": "yes",
  "system_requirements": "",
  "compliance": [
    "HIPAA",
    "HITECH",
    "SOC 2"
  ],
  "certifications": [
    "FDA 510(k)",
    "CE/MDR",
    "ONC",
    "ISO 27001"
  ],
  "security_features": [
    "Encryption (in transit and at rest)",
    "Role-based access control (RBAC)",
    "SSO/SAML support",
    "Audit logging"
  ],
  "privacy_features": [
    "Business Associate Agreement (BAA) available",
    "Data minimization and controlled access"
  ],
  "data_residency": "US and global deployment/managed options (contact vendor for region-specific hosting)",
  "customers": [
    "OptumCare",
    "Optum Advisory Services",
    "OptumRx",
    "AdvancedMD",
    "Tebra",
    "TriZetto QNXT",
    "MicroMD PM",
    "Essentials",
    "Waystar",
    "RXNT",
    "Spyglass",
    "eClaimStatus",
    "CareMe Health",
    "Surest (Bind) Health Insurance"
  ],
  "user_reviews": [
    "Optum not the best. Any issue, project or task is so difficult with Optumcare because they outsource all of their workers overseas. This makes communicating very difficult. Only specific plans use on shore representatives, and that is if that company pays extra for that.",
    "Nothing. Any issue, project or task is so difficult with Optumcare because they outsource all of their workers overseas. This makes communicating very difficult. Only specific plans use on shore representatives, and that is if that company pays extra for that.",
    "NOTHING. There is nothing at all that I have come to find that I like with any optum product. Again support is very limited and anyone at any location has no clue as to what is going on and cannot advise anything to you when you are in need of help.",
    "Everything. I dislike the lack of communication amongst products. I wouldn't say I like the lack of communication for providers to seek help or even attempt to troubleshoot. You are forced to obtain their products. One section of the company never knows how to send you to the appropriate team for specifics, as everyone that you can get through can never help you. Again, this is all contributed to the language barrier for this company employing all overseas workers. Some of the appropriate departments you need to speak with do not have a way to communicate with them directly. All of this contributes to not having a good relationship with OptumCare. If you want to be contracted with United Healthcare then you are forced to get several Optum products and you have to sign up for each one.",
    "If you can avoid it then do but it is very difficult to avoid, especially if you want to be in network with United.",
    "User friendly, easy to navigate through and efficient.",
    "Layout, needs to be refreshed colors are boring.",
    "Optum Rx is Efficiency and Ease. I am closely associated with someone who has been using OptumRx for managing their prescription benefits, and overall, their experience has been positive. The convenience of their online platform for ordering refills and tracking shipments has made the prescription process more efficient. One of the standout features is the user-friendly website, which provides easy navigation to find medication details, order history, and cost information. The option to receive notifications about order status and shipping updates is a helpful addition, ensuring awareness of the status of prescriptions.",
    "However, like any service, there's always room for improvement. Occasionally, there were delays in processing and shipping, but these instances were infrequent and usually promptly resolved after contacting customer support.",
    "OptumRx solves the challenges of managing prescriptions by offering a centralized online platform. It streamlines the process of ordering refills, tracking shipments, and understanding medication costs. This convenience saves time, enhances cost transparency, and ensures timely fulfillment of prescriptions, contributing to improved medication adherence. Responsive customer service addresses inquiries promptly, making the overall prescription management experience efficient and user-friendly."
  ],
  "ratings": [
    "OptumCare: 3.9/5 (7 reviews) - G2",
    "Optum Advisory Services: 3.3/5 (17 reviews) - G2",
    "OptumCare: 3.4/5 (25 reviews) - G2"
  ],
  "support_channels": [
    "email",
    "phone",
    "chat",
    "ticketing",
    "community",
    "24x7"
  ],
  "training_options": [
    "documentation",
    "webinars",
    "live_online",
    "onsite",
    "certification"
  ],
  "release_year": "2000",
  "integration_partners": [
    "AdvancedMD",
    "Tebra",
    "TriZetto QNXT",
    "MicroMD PM",
    "Essentials",
    "Waystar",
    "RXNT",
    "Spyglass",
    "eClaimStatus",
    "CareMe Health",
    "Surest (Bind) Health Insurance"
  ],
  "id": "SW1203",
  "slug": "a-r-recovery-and-denial-management",
  "type": "product",
  "version": "1.0",
  "last_updated": "2025-10-11",
  "links_json": {
    "self": "https://www.healthaidb.com/software/a-r-recovery-and-denial-management.json"
  }
}