Optum Revenue Cycle Management (RCM) solutions offer a holistic, end-to-end approach to transforming the revenue cycle in healthcare. The suite combines leading clinical and payer insights with intelligent automation to improve financial performance, decrease administrative costs, and unlock new sources of growth. Key software components include Optum Integrity One, a new AI-powered integrated platform that consolidates middle RCM functions—such as clinical documentation integrity (CDI), facility/professional coding, and auditing—into a single, easy-to-use interface. This platform leverages Optum Clinical Language Intelligence™ to automate tasks from the point of care through final coding, enhancing documentation accuracy, minimizing denials, and securing appropriate reimbursements.
Another core component is Acuity Revenue Cycle Analytics™, which provides analytics-driven software for providers. It offers real-time data and responsive, cloud-based reporting, including daily/monthly dashboards and denial/cash flow forecasting, enabling timely decision-making that impacts financial outcomes and staff productivity.
The comprehensive RCM offering supports the full spectrum of revenue cycle functions, including patient access, insurance verification, authorization management, claim creation and submission, delinquent claim management, and patient financial engagement solutions. The system is designed to integrate seamlessly with existing EHR systems, offering an agnostic approach to meet diverse billing needs.
Target Users and Use Cases: The primary target market is large healthcare entities, including health systems, hospitals, and multispecialty practices. Use cases include Clinical Documentation Integrity (CDI), autonomous and partially autonomous medical coding, denial management, patient access, and overall financial performance optimization.