Hospital Group Says UnitedHealth AI System Reduces Claims Denials

An artificial intelligence system from UnitedHealth Group has reportedly sped up prior authorization requests and reduced medical claims denials “meaningfully” during testing at Minneapolis-based hospital system Allina Health .

The Optum Real system, which is designed to streamline medical claims processing, has reduced denials by flagging claims that need more documentation before they are submitted, Bloomberg reported Tuesday (Oct. 21).

Dave Ingham , chief digital and information officer at Allina Health, told Bloomberg that the AI system avoids the disappointment of denials and reduces paperwork.

The Optum Real system was developed by UnitedHealth’s Optum Insight unit and connects with UnitedHealth’s insurance division, UnitedHealthcare , according to the report.

The company aims to add more insurance and providers to the system by providing them with lower transaction costs, Optum Insight CEO Sandeep Dadlani told Bloomberg.

Optum Insight does not charge a fee for those companies to connect to the system’s core functions, the report said. Instead, it plans to make money by helping them digitize their information and by providing companies with advanced analytics and other premium features, per the report.

It was reported in May that UnitedHealth Group had 1,000 AI applications in production and was using the technology across its business, including its insurance, health delivery and pharmacy divisions.

For example, the company uses AI to transcribe conversations from clinician visits, summarize data, process claims, control customer-facing chatbots and write software.

During UnitedHealth Group’s January earnings call, Dadlani, who was the company’s chief technology officer at the time, said digital technology had reduced call center calls by 10% over the previous year.

“Our AI, digital automation and our modernization agenda has focused largely on removing administrative menial tasks in the system and improving the customer experience,” Dadlani said.

According to Google Cloud ’s The ROI of AI in Healthcare and Life Sciences report, 44% of executives in these industries have AI agents in production. The report, based on a global survey of more than 600 healthcare and life sciences leaders, found that nearly half of organizations are allocating more than 50% of their future AI budgets to agents.

The PYMNTS Intelligence report “ Healthcare Firms Going Long on Gen AI Investment ” found that 90% of healthcare executives said that their previous investments in generative AI had already achieved a positive return on investment.

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