May 7, 2025

Optum leads revenue cycle management innovation with new AI-powered solution

(May 7, 2025) Optum is reducing administrative burden for health systems through Optum Integrity One, its new integrated revenue cycle platform powered by Optum Clinical Language Intelligence™. The platform enhances clinical documentation and coding accuracy, enabling timely and accurate billing for providers.

Building on its leadership in revenue cycle management (RCM), Optum Integrity One seamlessly consolidates several RCM functions into a single, easy to use interface, allowing hospital staff to remove manual work in multiple platforms and improve efficiency. The solution leverages AI to automate revenue cycle tasks from point of care through final coding such as reviewing clinical documentation, assigning codes and capturing services for billing. This facilitates accurate documentation and billing, allowing providers to receive proper reimbursement, helping patients avoid surprise charges, and enabling more efficient claims processing.

Optum Integrity One provides both fully autonomous and partially autonomous coding, offering the flexibility to keep a human in the loop for complex or specialized cases, while adhering to responsible and ethical use of AI practices. A recent pilot program with a health system has shown a coding productivity increase of over 20%.

“We’re harnessing the power of AI to reduce administrative burden for providers by enabling accurate documentation that supports quality care and validates medical necessity,” said Lorri Sides, RN, BSN, vice president, product management at Optum Insight. “Optum Integrity One delivers on our commitment to create a simple, modernized health care experience for everyone.”

Recent studies show 70% of health care organizations  are pursuing AI in areas such as operations and claims management. Incorporating AI into key components of the RCM process can enhance efficiency and address staffing shortages, which account for 62% of open positions in roles like clinical documentation integrity and medical coding.

Powering clinical and administrative action with AI

• Backed by over 20 years of expertise and more than 166 million cases processed each year, Optum is now using the latest AI models to power the next generation of advanced technology, creating a smarter and more efficient health care experience.
• Clinical Language Intelligence™ addresses the challenge of interpreting complex clinical information by leveraging a carefully curated knowledge graph. This enables AI to deliver more accurate results in identifying documentation gaps and translating clinical concepts into standardized coding systems.

As a leader in RCM, Optum continues to drive successful financial and clinical experiences across the entire revenue cycle for both patients and providers. With responsible use of AI and evidence-based insights, these solutions reduce administrative burden for providers and elevate the patient experience.

Learn more about Optum Integrity One.