Claims Manager

JSON twin: https://www.healthaidb.com/software/claims-manager.json

Company Name

Optum

Product URL

https://business.optum.com/en/operations-technology/revenue-cycle-management/reimbursement/claims-manager.html

Company URL

https://www.optum.com

Categories

• administrative Operations
• revenue Cycle
• Administrative
• Revenue Cycle Management
• Claims Management

Summary

Optum Claims Manager is a healthcare software solution designed to pre-screen claims for coding errors and unbilled services before submission, aiming to reduce denials and enhance revenue.

Description

Optum Claims Manager utilizes a rules-based engine powered by the Optum KnowledgeBase, containing over 132 million code-to-code relationships, to detect clinical coding errors and unbilled services prior to claim submission. This proactive approach helps healthcare organizations improve cash flow by identifying billing and coding inaccuracies early, potentially achieving up to a 23:1 return on investment. The solution integrates seamlessly with existing practice management systems, allowing users to work within their current workflows. Additionally, it maintains compliance with government and commercial billing regulations through automated solutions developed by clinical and technical experts. Clients have reported significant improvements in efficiency, accuracy, and cost savings. For more detailed information, visit the official product page: ([business.optum.com](https://business.optum.com/en/operations-technology/revenue-cycle-management/reimbursement/claims-manager.html?utm_source=openai))

Api Available

unknown

Certifications

Company Founding

2011

Company Offices

• United States

Compliance

• HIPAA

Customers

• Silna Health
• AdvancedMD
• Tebra
• TriZetto QNXT
• MicroMD PM
• athenaOne
• Waystar
• RXNT
• Spyglass
• eClaimStatus
• Inovalon Claims Management Pro

Data Residency

Primarily US-based hosting with global/enterprise deployment options (cloud regions and hybrid deployments available)

Data Standards

• ANSI X12 837 Professional (EDI 837)
• ASC X12

Deployment Model

• SaaS
• cloud-hosted
• hybrid

Features

• Claims editing engine to pre-screen claims prior to submission
• Custom editing tools and rules management
• Automated detection of billing and coding inaccuracies
• Alerts to providers within existing provider workflow
• Identify and capture unbilled services
• Denial prevention and reduction
• Revenue capture and cash-flow improvement
• Regulatory/commercial billing rules maintenance

Id

SW1943

Integration Partners

• Inovalon
• AdvancedMD
• Tebra
• TriZetto QNXT
• MicroMD PM
• athenaOne
• Waystar
• RXNT
• Spyglass
• eClaimStatus

Integrations

• Epic
• Optum Coding
• Optum360
• Hospital billing systems (e.g., Epic Resolute)
• Practice management systems

Languages Supported

• English

Last Updated

2025-10-11

License

commercial

Market Segment

• enterprise
• smb

Optional Modules

Os Platforms

• Web

Pricing Details

Contact vendor for pricing information.

Pricing Model

subscription

Privacy Features

• Profile suppression to reduce PHI/identity risk

Product Code

SW1943

Product Name

Claims Manager

Ratings

• 4.5 out of 5 on G2
• 4.1 out of 5 on G2
• 4.2 out of 5 on G2
• 4.3 out of 5 on G2
• 4.4 out of 5 on G2

Regions Available

• United States

Related Urls

• https://elion.health/products/optum-claims-manager

Release Year

2017

Security Features

• Encryption at rest and in transit (TLS)
• Role-based access control (RBAC)
• SSO / SAML / OAuth2 support
• Audit logging and monitoring
• Multi-factor authentication (MFA/2FA)

Specialties

• General Healthcare
• Medical Billing
• Coding Compliance

Support Channels

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

System Requirements

Target Users

• admins
• revenue cycle managers
• billing specialists

Training Options

• documentation
• webinars
• live_online
• onsite
• certification

Type

product

User Reviews

• It is very end user friendly and easy navigation.
• User friendly! Easy to train staff members.
• Could be better with mobile app development.

Version

1.0

Alternatives

See related products

Canonical JSON

{
  "product_name": "Claims Manager",
  "company_name": "Optum",
  "product_url": "https://business.optum.com/en/operations-technology/revenue-cycle-management/reimbursement/claims-manager.html",
  "company_url": "https://www.optum.com",
  "related_urls": [
    "https://elion.health/products/optum-claims-manager"
  ],
  "product_code": "SW1943",
  "summary": "Optum Claims Manager is a healthcare software solution designed to pre-screen claims for coding errors and unbilled services before submission, aiming to reduce denials and enhance revenue.",
  "description": "Optum Claims Manager utilizes a rules-based engine powered by the Optum KnowledgeBase, containing over 132 million code-to-code relationships, to detect clinical coding errors and unbilled services prior to claim submission. This proactive approach helps healthcare organizations improve cash flow by identifying billing and coding inaccuracies early, potentially achieving up to a 23:1 return on investment. The solution integrates seamlessly with existing practice management systems, allowing users to work within their current workflows. Additionally, it maintains compliance with government and commercial billing regulations through automated solutions developed by clinical and technical experts. Clients have reported significant improvements in efficiency, accuracy, and cost savings. For more detailed information, visit the official product page: ([business.optum.com](https://business.optum.com/en/operations-technology/revenue-cycle-management/reimbursement/claims-manager.html?utm_source=openai))",
  "categories": [
    "administrative Operations",
    "revenue Cycle",
    "Administrative",
    "Revenue Cycle Management",
    "Claims Management"
  ],
  "market_segment": [
    "enterprise",
    "smb"
  ],
  "target_users": [
    "admins",
    "revenue cycle managers",
    "billing specialists"
  ],
  "specialties": [
    "General Healthcare",
    "Medical Billing",
    "Coding Compliance"
  ],
  "regions_available": [
    "United States"
  ],
  "languages_supported": [
    "English"
  ],
  "pricing_model": "subscription",
  "pricing_details": "Contact vendor for pricing information.",
  "license": "commercial",
  "company_offices": [
    "United States"
  ],
  "company_founding": "2011",
  "deployment_model": [
    "SaaS",
    "cloud-hosted",
    "hybrid"
  ],
  "os_platforms": [
    "Web"
  ],
  "features": [
    "Claims editing engine to pre-screen claims prior to submission",
    "Custom editing tools and rules management",
    "Automated detection of billing and coding inaccuracies",
    "Alerts to providers within existing provider workflow",
    "Identify and capture unbilled services",
    "Denial prevention and reduction",
    "Revenue capture and cash-flow improvement",
    "Regulatory/commercial billing rules maintenance"
  ],
  "optional_modules": [],
  "integrations": [
    "Epic",
    "Optum Coding",
    "Optum360",
    "Hospital billing systems (e.g., Epic Resolute)",
    "Practice management systems"
  ],
  "data_standards": [
    "ANSI X12 837 Professional (EDI 837)",
    "ASC X12"
  ],
  "api_available": "unknown",
  "system_requirements": "",
  "compliance": [
    "HIPAA"
  ],
  "certifications": [],
  "security_features": [
    "Encryption at rest and in transit (TLS)",
    "Role-based access control (RBAC)",
    "SSO / SAML / OAuth2 support",
    "Audit logging and monitoring",
    "Multi-factor authentication (MFA/2FA)"
  ],
  "privacy_features": [
    "Profile suppression to reduce PHI/identity risk"
  ],
  "data_residency": "Primarily US-based hosting with global/enterprise deployment options (cloud regions and hybrid deployments available)",
  "customers": [
    "Silna Health",
    "AdvancedMD",
    "Tebra",
    "TriZetto QNXT",
    "MicroMD PM",
    "athenaOne",
    "Waystar",
    "RXNT",
    "Spyglass",
    "eClaimStatus",
    "Inovalon Claims Management Pro"
  ],
  "user_reviews": [
    "It is very end user friendly and easy navigation.",
    "User friendly! Easy to train staff members.",
    "Could be better with mobile app development."
  ],
  "ratings": [
    "4.5 out of 5 on G2",
    "4.1 out of 5 on G2",
    "4.2 out of 5 on G2",
    "4.3 out of 5 on G2",
    "4.4 out of 5 on G2"
  ],
  "support_channels": [
    "email",
    "phone",
    "chat",
    "ticketing",
    "community",
    "24x7"
  ],
  "training_options": [
    "documentation",
    "webinars",
    "live_online",
    "onsite",
    "certification"
  ],
  "release_year": "2017",
  "integration_partners": [
    "Inovalon",
    "AdvancedMD",
    "Tebra",
    "TriZetto QNXT",
    "MicroMD PM",
    "athenaOne",
    "Waystar",
    "RXNT",
    "Spyglass",
    "eClaimStatus"
  ],
  "id": "SW1943",
  "slug": "claims-manager",
  "type": "product",
  "version": "1.0",
  "last_updated": "2025-10-11",
  "links_json": {
    "self": "https://www.healthaidb.com/software/claims-manager.json"
  }
}