JSON twin: https://www.healthaidb.com/software/optum-claims-manager.json
Optum
Rules-based claim-editing and pre-submission scrubbing platform that prevents denials, captures missed revenue and integrates with practice management/EHR workflows.
Optum Claims Manager is a commercial claims pre-processing and editing solution that applies a comprehensive rules engine (Optum KnowledgeBase and custom rules) to scrub claims before payer submission, identify unbilled services, reduce denials, maintain regulatory compliance, and integrate into existing practice management/EHR and EDI workflows.
unknown
2011
P1204
2025-09-07
commercial proprietary
Contact vendor for licensing, implementation and subscription pricing; sales/demo available via Optum business team
enterprise_quote
2005
product
1.0
{
"company_name": "Optum",
"company_url": "https://www.optum.com",
"company_offices": [
"United States",
"India",
"Brazil",
"Ireland",
"United Kingdom"
],
"company_founding": "2011",
"product_url": "https://business.optum.com/en/operations-technology/revenue-cycle-management/reimbursement/claims-manager.html",
"categories": [
"administrative",
"revenue cycle management",
"billing",
"payment integrity",
"claims editing"
],
"market_segment": [
"enterprise"
],
"links": [
"https://business.optum.com/en/operations-technology/revenue-cycle-management/reimbursement/claims-manager.html",
"https://business.optum.com/en/operations-technology/revenue-cycle-management/reimbursement.html",
"https://www.optum.com/en/about-us.html",
"https://business.optum.com/content/dam/o4-dam/resources/pdfs/sell-sheets/ClaimsManagerProfessionalSellSheet.pdf",
"https://elion.health/products/optum-claims-manager",
"https://klasresearch.com/review/optum-claims-manager/1278",
"https://www.optum.com.br/content/dam/optum/resources/productSheets/ClaimsMgr5Professional_Sellsheet_v3.pdf",
"https://marketplace.optum.com/products/payment_and_reimbursement/assurance-reimbursement-management.html",
"https://www.unitedhealthgroup.com/"
],
"summary": "Rules-based claim-editing and pre-submission scrubbing platform that prevents denials, captures missed revenue and integrates with practice management/EHR workflows.",
"description": "Optum Claims Manager is a commercial claims pre-processing and editing solution that applies a comprehensive rules engine (Optum KnowledgeBase and custom rules) to scrub claims before payer submission, identify unbilled services, reduce denials, maintain regulatory compliance, and integrate into existing practice management/EHR and EDI workflows.",
"target_users": [
"billing staff",
"medical coders",
"revenue cycle managers",
"revenue integrity teams",
"practice administrators",
"payers (integration partners)"
],
"specialties": [
"revenue cycle management",
"medical billing & coding",
"ambulatory care",
"hospital/health system billing",
"specialty practices (orthopedics, cardiology, etc.)"
],
"regions_available": [
"United States",
"United Kingdom",
"India",
"Brazil",
"Canada",
"Australia",
"Singapore"
],
"languages_supported": [
"English",
"Spanish",
"Chinese (Simplified/Traditional)"
],
"pricing_model": "enterprise_quote",
"pricing_details": "Contact vendor for licensing, implementation and subscription pricing; sales/demo available via Optum business team",
"license": "commercial proprietary",
"deployment_model": [],
"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": [
"Practice management systems"
],
"data_standards": [
"ANSI X12 837 Professional (EDI 837)",
"ASC X12"
],
"api_available": "unknown",
"system_requirements": "",
"compliance": [
"HIPAA"
],
"certifications": [],
"security_features": [],
"privacy_features": [],
"data_residency": "",
"customers": [
"Santa Clara County",
"UCLA Health",
"Weill Cornell Medicine",
"Rowan University"
],
"user_reviews": [
"I would recommend Claims Manager. I'm always pro-Optum. The solution saves us a ton of money when we...",
"The platform's management is pretty user friendly from a digital...",
"I wish Claims Manager could catch all of our coding-related denials by...",
"Optum has out-of-the-box trainings and webinars, and those are...",
"I like that Optum has continuous support. It is easy to get help with..."
],
"ratings": [
"KLAS Research — Claims Manager: 94.1 (KLAS listing / Best in KLAS report references)"
],
"support_channels": [
"phone",
"email",
"webinars",
"ticketing",
"onsite",
"live chat",
"training portal"
],
"training_options": [
"documentation",
"webinars",
"live_online",
"onsite",
"training modules"
],
"release_year": "2005",
"integration_partners": [
"Epic",
"Optum Coding / OptumCoding",
"Optum360",
"Hospital billing systems (e.g., Epic Resolute)"
],
"id": "P1204",
"slug": "optum-claims-manager",
"type": "product",
"version": "1.0",
"last_updated": "2025-09-07",
"links_json": {
"self": "https://www.healthaidb.com/software/optum-claims-manager.json"
}
}