Coverage Insight
JSON twin: https://www.healthaidb.com/software/coverage-insight.json
Company Name
Optum
Product URL
https://business.optum.com/en/operations-technology/revenue-cycle-management/patient-access/coverage-insight.html
Company URL
https://www.optum.com
Categories
Summary
Optum's Coverage Insight is an analytics-driven insurance discovery software that identifies undisclosed coverage for patients, aiming to reduce self-pay accounts and recover revenue for healthcare providers.
Description
Coverage Insight utilizes advanced data mining, machine learning, and predictive analytics to uncover hidden insurance coverage for patients classified as self-pay or underinsured. It integrates with payer networks to validate insurance and demographic information, helping providers recover revenue that might otherwise be lost. The platform also includes a suppression feature to mitigate identity fraud risk and supports pre- and post-service coverage analysis to reduce denials and improve the patient financial experience.
Api Available
unknown
Certifications
Company Founding
2011
Company Offices
Compliance
- HIPAA
- CMS anti-phishing mandate
Customers
- OptumCare
- Optum Advisory Services
- Optum Financial HSA
Data Residency
US-only
Data Standards
- HL7
- FHIR
- DICOM
- SNOMED
- ICD-10
Deployment Model
Features
- Insurance discovery and coverage identification for self-pay accounts
- Advanced data mining and machine learning for payer matching
- Predictive analytics and hit-rate scoring
- Demographic and historical profile enrichment (names, addresses, employers)
- Direct payer and third-party connections for verification
- Identity-risk suppression (rejects high-risk profiles)
- Support for CMS anti-phishing requirements
- Prioritization of billable coverage/payer targeting
- Continuous/real-time screening (results typically within 24 hours)
- Reporting/analytics on uncovered coverage and recovery impact
Id
SW1945
Integration Partners
- Corsica Technologies
- Forma
- Lively HSA
- WEX Benefits
- HealthEquity
- Fidelity HSA
Integrations
- Medicaid
- Medicare
- Commercial payers
- Direct payer connections (Optum payer network)
Languages Supported
- English
- Spanish
- Chinese (Mandarin)
- Portuguese
Last Updated
2025-10-11
License
proprietary/commercial
Market Segment
Optional Modules
Os Platforms
Pricing Details
Contact vendor for pricing; pay-per-account options (percent or fixed fee per benefit unit) and enterprise arrangements; request demo/trial via sales form.
Pricing Model
enterprise_quote
Privacy Features
- Profile suppression to reduce PHI/identity risk
Product Code
SW1945
Product Name
Coverage Insight
Ratings
- 3.3 out of 5 (17 reviews) - Optum Advisory Services
- 3.8 out of 5 (11 reviews) - healthgrades Quality Solutions
- 3.9 out of 5 (7 reviews) - OptumCare
- 2.5 out of 5 (1 review) - Optum Financial HSA
- 4.4 out of 5 (25 reviews) - Corsica Technologies
- 4.9 out of 5 (615 reviews) - Forma
- 4.7 out of 5 (100 reviews) - Lively HSA
- 3.6 out of 5 (56 reviews) - WEX Benefits
- 3.9 out of 5 (7 reviews) - HealthEquity
- 4.5 out of 5 (2 reviews) - Fidelity HSA
Regions Available
Related Urls
Release Year
2010
Security Features
- Identity-risk suppression
- Data validation/screening
Specialties
Support Channels
- email
- phone
- chat
- ticketing
- community
- 24x7
System Requirements
Target Users
- hospital revenue cycle teams
- patient access staff
- billing and collections teams
- health system administrators
- providers
- payers
- third-party billing services
Training Options
- documentation
- webinars
- live_online
- onsite
- certification
Type
product
User Reviews
- 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.
- Currently, I am not solving any issues with them. I do not have any direct benefits that I can provide as a review for OptumCare because I find that, other companies operate better than them. However, if you want to be involved with United Healthcare, then you are forced to get several different products with OptumCare.
Version
1.0
Alternatives
See related products
Canonical JSON
{
"product_name": "Coverage Insight",
"company_name": "Optum",
"product_url": "https://business.optum.com/en/operations-technology/revenue-cycle-management/patient-access/coverage-insight.html",
"company_url": "https://www.optum.com",
"related_urls": [
"https://elion.health/products/optum-coverage-insights"
],
"product_code": "SW1945",
"summary": "Optum's Coverage Insight is an analytics-driven insurance discovery software that identifies undisclosed coverage for patients, aiming to reduce self-pay accounts and recover revenue for healthcare providers.",
"description": "Coverage Insight utilizes advanced data mining, machine learning, and predictive analytics to uncover hidden insurance coverage for patients classified as self-pay or underinsured. It integrates with payer networks to validate insurance and demographic information, helping providers recover revenue that might otherwise be lost. The platform also includes a suppression feature to mitigate identity fraud risk and supports pre- and post-service coverage analysis to reduce denials and improve the patient financial experience.",
"categories": [
"administrative Operations",
"revenue Cycle",
"patient Access",
"eligibility Verification",
"health Data Analytics",
"Administrative",
"Revenue-cycle-management",
"Patient-access",
"Eligibility-verification",
"Analytics"
],
"market_segment": [
"enterprise"
],
"target_users": [
"hospital revenue cycle teams",
"patient access staff",
"billing and collections teams",
"health system administrators",
"providers",
"payers",
"third-party billing services"
],
"specialties": [
"Revenue Cycle Management",
"Patient Access",
"Medical Billing",
"Payment Integrity",
"Claims Management"
],
"regions_available": [
"United States"
],
"languages_supported": [
"English",
"Spanish",
"Chinese (Mandarin)",
"Portuguese"
],
"pricing_model": "enterprise_quote",
"pricing_details": "Contact vendor for pricing; pay-per-account options (percent or fixed fee per benefit unit) and enterprise arrangements; request demo/trial via sales form.",
"license": "proprietary/commercial",
"company_offices": [
"United States"
],
"company_founding": "2011",
"deployment_model": [
"SaaS"
],
"os_platforms": [
"Web"
],
"features": [
"Insurance discovery and coverage identification for self-pay accounts",
"Advanced data mining and machine learning for payer matching",
"Predictive analytics and hit-rate scoring",
"Demographic and historical profile enrichment (names, addresses, employers)",
"Direct payer and third-party connections for verification",
"Identity-risk suppression (rejects high-risk profiles)",
"Support for CMS anti-phishing requirements",
"Prioritization of billable coverage/payer targeting",
"Continuous/real-time screening (results typically within 24 hours)",
"Reporting/analytics on uncovered coverage and recovery impact"
],
"optional_modules": [],
"integrations": [
"Medicaid",
"Medicare",
"Commercial payers",
"Direct payer connections (Optum payer network)"
],
"data_standards": [
"HL7",
"FHIR",
"DICOM",
"SNOMED",
"ICD-10"
],
"api_available": "unknown",
"system_requirements": "",
"compliance": [
"HIPAA",
"CMS anti-phishing mandate"
],
"certifications": [
"HITRUST Certified",
"SOC 2"
],
"security_features": [
"Identity-risk suppression",
"Data validation/screening"
],
"privacy_features": [
"Profile suppression to reduce PHI/identity risk"
],
"data_residency": "US-only",
"customers": [
"OptumCare",
"Optum Advisory Services",
"Optum Financial HSA"
],
"user_reviews": [
"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.",
"Currently, I am not solving any issues with them. I do not have any direct benefits that I can provide as a review for OptumCare because I find that, other companies operate better than them. However, if you want to be involved with United Healthcare, then you are forced to get several different products with OptumCare."
],
"ratings": [
"3.3 out of 5 (17 reviews) - Optum Advisory Services",
"3.8 out of 5 (11 reviews) - healthgrades Quality Solutions",
"3.9 out of 5 (7 reviews) - OptumCare",
"2.5 out of 5 (1 review) - Optum Financial HSA",
"4.4 out of 5 (25 reviews) - Corsica Technologies",
"4.9 out of 5 (615 reviews) - Forma",
"4.7 out of 5 (100 reviews) - Lively HSA",
"3.6 out of 5 (56 reviews) - WEX Benefits",
"3.9 out of 5 (7 reviews) - HealthEquity",
"4.5 out of 5 (2 reviews) - Fidelity HSA"
],
"support_channels": [
"email",
"phone",
"chat",
"ticketing",
"community",
"24x7"
],
"training_options": [
"documentation",
"webinars",
"live_online",
"onsite",
"certification"
],
"release_year": "2010",
"integration_partners": [
"Corsica Technologies",
"Forma",
"Lively HSA",
"WEX Benefits",
"HealthEquity",
"Fidelity HSA"
],
"id": "SW1945",
"slug": "coverage-insight",
"type": "product",
"version": "1.0",
"last_updated": "2025-10-11",
"links_json": {
"self": "https://www.healthaidb.com/software/coverage-insight.json"
}
}