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Developing Medicaid Core Set measures for States

Article

Developing Medicaid Core Set measures for States

Discover how Michigan and Virginia took different approaches to meet the federal mandate of tracking care quality for Medicaid and CHIP.

Rewiring the RCM Playbook [White Paper]

White paper

Rewiring the RCM Playbook

Discover how to advance revenue cycle management with AI-driven strategies for healthcare success.

What Health Plans Need to Know About Provider Usage of AI

Article

What health plans need to know about provider usage of AI

Uncover the 4 major ways providers are leveraging AI and how this trend is changing payment integrity for health plans.

The New AI Approach to Eliminating Contract-Based Errors

Article

The new AI approach to eliminating contract-based errors

Learn how we're leveraging AI to help minimize payment errors associated with manual contract reviews.  

 

 

Latest articles

Developing Medicaid Core Set measures for States

Article

Developing Medicaid Core Set measures for States

Discover how Michigan and Virginia took different approaches to meet the federal mandate of tracking care quality for Medicaid and CHIP.

What Health Plans Need to Know About Provider Usage of AI

Article

What health plans need to know about provider usage of AI

Uncover the 4 major ways providers are leveraging AI and how this trend is changing payment integrity for health plans.

 

 

Latest case studies and testimonials

State Health Insurance Exchange Modernization

Case study

A proven path to stable, reliable, scalable modernization

Learn how a more than 10-year collaboration led to a seamless enrollment experience in 2025 for millions of consumers in Medicaid and QHP plans.

Empowering Providers to Focus on What Matters Most: Patient Care

Case study

Empowering providers to focus on patient care

Our provider performance team partners with your providers to reduce administrative burden and drive positive patient outcomes.

Improving Performance at Excel Medical Center

Case study

Improving performance at Excel Medical Center

Empower provider success and improve member care through digital integration.

 

 

Latest e-books

Payment Integrity Strategies That Generate Savings Quickly

E-book

Payment integrity strategies that help generate savings quickly

This guide can help you optimize your payment integrity program and achieve savings goals within 12 months.

Steps to Smarter Prior Authorization

E-book

Steps to smarter prior authorization

Healthcare organizations face challenges with prior authorization. Learn how automation can help save resources and improve patient care.

 

 

Latest guides

Engage Providers to Impact Member Outcomes [Infographic]

Guide

Engage providers impact member outcomes

Download our infographic to learn how Optum can take the burden off payers to impact provider performance.

6 Workforce Strategies for Healthcare Leaders

Guide

6 workforce strategies for healthcare leaders

Strengthen and inspire your healthcare workforce. Our actionable toolkit offers new strategies to reconnect with talent, simplify workflows and more.

Developing an Industry-leading Middle Revenue Cycle for Hospitals

Guide

Developing an industry-leading middle revenue cycle for hospitals

Explore the six focus areas for improving performance to create an industry-leading middle revenue cycle for your hospital.

 

 

Latest on-demand webinars

Navigating the Complexities of Healthcare Automation

On-demand webinar

Navigating the complexities of healthcare automation

Learn how to assess your organization’s readiness for automation. Get strategies to unlock the full potential of your automation investments.

Adapting to the Changes in Medicaid Policies

On-demand webinar

Adapting to the changes in Medicaid policies

The upcoming changes to Medicaid policies are set to significantly impact organizational operations.

 

 

Latest white papers

Rewiring the RCM Playbook [White Paper]

White paper

Rewiring the RCM Playbook

Discover how to advance revenue cycle management with AI-driven strategies for healthcare success.

5 AI Use Cases in Payment Integrity [White Paper]

White paper

5 AI use cases in payment integrity

A strategic blueprint to modernize your payment integrity program through intelligent, AI-driven health plan operations.

Transform Your Risk Adjustment Strategy

White paper

Transform your risk adjustment strategy

A strategic risk adjustment analytics framework guide for health plans.

 

 

Latest videos

Exploring the Evolving Landscape of Autonomous Coding [Video]

Video

Exploring the evolving landscape of autonomous coding

This panel will address autonomous coding trends, challenges and innovations within the middle revenue cycle.

Advancing DME Benefits Management with DME Navigator

Video

Advancing dme benefits management

Learn how DME Navigator can help streamline durable medical equipment (DME) benefits management. 

  

 All technology and automation insights

Navigating the future of healthcare financial growth

Explore expert-led strategies to boost financial resilience and long-term growth in today’s evolving healthcare landscape.

Enhance system security with cloud-native imaging solutions

Learn about the in-depth security capabilities of cloud-native imaging.

Market for patient engagement webinar

View the public launch of Optum Patient Access and Engagement on demand.

Streamline clinical value analysis processes in a growing surgical market

Access resources on how to reduce surgical costs for your health system.

Using the cloud for medical imaging

Learn how to unlock the power of cloud migration in your medical imaging.

Optum Recognized as RCM Leader Report

Optum is honored to be recognized as a Leader in the Everest Group RCM Platforms PEAK Matrix Assessment for 2025, highlighting our comprehensive RCM solutions.

Adventist West’s success through redesigning and automating UM

Discover how to leverage automation for centralized, exception-based utilization management.

Improving CDI efficiency

See how Lima Memorial improved efficiency with advanced technology.

Imaging, data reporting and the cardiology user experience

How can cardiovascular imaging departments leverage user experience design to address the challenges of fragmented data?

Generative AI’s role in modern healthcare delivery

Discover how generative artificial intelligence (AI) is reshaping healthcare by boosting speed, precision and care.

How Cardiology IT solutions can solve workflow issues

Learn how new reporting features within cardiology IT solutions helped one medical center build an innovative user experience and workflow.

Breast density: Research for Radiologists

New research on breast density is changing the way radiologists approach mammography.

Focus on patients, not paperwork

Watch the webinar to learn actionable strategies on tackling decreased hospital margins, increased labor costs and staffing shortages.

How Optum supports value-based goals with powerful products

See how Optum’s products help hospitals succeed with value-based contracts, earning appropriate incentives and avoiding penalties.

Addressing burnout with cloud PACS solutions

Health care leaders share how cloud-native solutions can help ease risks and improve efficiency for radiologists.

How AI is delivering efficiencies for radiologists

Learn how AI solutions can boost your organization’s return on investment (ROI).

Improve physician practice revenue

Learn key strategies to strengthen the financial performance of your physician practice.

Making risk adjustment programs work

Learn how three care delivery organizations reduced administrative burden to spend more time with patients and improve outcomes.

Patient access starts before the appointment

New research reveals how access, transparency and digital tools shape patient satisfaction long before care begins.

Debunking revenue cycle myths: The path to financial health

Discover how partnering with a managed services partner can help improve financial operations.

Anesthesiology group improves rcm physician practices

How one anesthesiology medical group increased profitability, efficiency and stability with physician group management services from Optum.

The role of AI in enterprise imaging

Learn how AI is being used to improve imaging workflow management and help care providers collaborate more efficiently.

Understanding artificial intelligence for radiologists

Learn why implementing artificial intelligence in the radiology department shouldn't lead to panic.

Strong financial future through partnership

See how Boulder Community Health partnered with Optum to continue to successfully fund its mission.

Call centers and AI technology

Transform state contact centers into 24/7 problem solvers.

Trends shaping the future of clearinghouses

Discover 5 key trends that can help healthcare organizations streamline processes, minimize errors and deliver faster, more reliable services.

Emergency department performance metrics

Learn about the key metrics that should be monitored within your emergency department to improve financial performance and optimize efficiency.

New billing system improves financial performance

Radiology Associates of Nevada made a smooth transition to Optum as its new billing vendor. This significantly improved its financial performance.

Strengthening risk adjustment with payer and provider collaboration

Learn how Optum utilizes scale, innovation and strong partnerships to optimize risk adjustment services for both providers and payers.

Preparing for a rise in ambulatory surgical care

Explore market conditions driving the outpatient shift, considerations for patient selection and current opportunities in the ambulatory space.

Five things your denial rate isn't telling you

Learn 5 ways to make changes that will prevent and remediate denied claims.

Improve your radiology performance

Learn how Change Healthcare Radiology Solutions™ 14.2.1 can help your department improve diagnostic confidence.

Improve provider engagement mobile query

Respond to query opportunities in real time and get access to clinical and coding decision-making information with our secure mobile app.

Support risk adjustment with CDI technology

Clinical documentation integrity programs are expanding to support risk adjustment initiatives. Integrated CDI technologies are needed to support revenue and integrity.

Proactively renew dual eligibles for Medicaid

Learn how Optum uses AI, state-specific logic and robust workflows to help with proactive dual eligible Medicaid renewals.

Decrease denials strategy

Understanding the reasons for your claim denials is the first step to preventing them from happening in the future.

A/R recovery services provide continuity

Provider maintains A/R revenue continuity during HIS conversion.

Doubling down on the cloud

Learn how technology is advancing imaging workforce challenges and revenue.

Digital front door strategy improves patient experience

Discover how a digital patient engagement strategy can provide easier access, reduce cancellations, and enhance front-end collections.

Speed up the claims process with AI

Read about our Claims Automated Rules Engine (CARE).

Optum wins 2023 enabling technology leadership award

Optum won the 2023 North American Enabling Technology Leadership Award. 

From transformation to triumph

Read this executive summary about Optum Serve's need to stay competitive amid dynamic trends and customer demands.

Structured cardiovascular reporting

Learn how structured cardiovascular reporting can reduce late charges.

Understanding the benefits of single-database cardiology

Learn about our single-database cardiology solution that integrates with your EHR and VNA to help create a complete, unified cardiovascular record.

Access point-of-care ultrasound imaging data

Discover how centrally stored point-of-care ultrasound images can help your organization increase efficiency and improve revenue.

A case study on Excel Medical Center

Using digital integration to ease administrative burdens can help you spend more time with patients and deliver positive patient outcomes.

MIPS program recommendations physicians

Traditional MIPS plans concluded in 2023. Understand MIPS reporting types and get help navigating the changes.

Improving transparency in payer-provider connections

Explore how real-time connections can enable more accurate claim submission to create a more efficient healthcare payment system.

Payment integrity strategies that help generate savings quickly

This guide can help you optimize your payment integrity program and achieve savings goals within 12 months.

Addressing challenges with CDI and coding

Read the success story to hear how Optum technology helped increase John Muir Health's monthly CDI case review average by 22%.

Designing cardiac training programs through innovation

Learn how we’re training the next generation of cardiac clinicians with advanced technology.

Strengthen your surgical capacity

Learn how to optimize surgical capacity by implementing and sustaining a highly-effective block management process.

The benefits of cardiovascular structured reporting

Discover the key features of cardiovascular structured reporting that drive adoption, EHR integration and customization.

Maximizing CareSelect Imaging for value-based care

Discover how to transform your approach to clinical decision-making and advance your organization’s value-based care goals.

Get competitive with CDI and coding analytics

Watch the demo to learn how our analytics platform provides custom, value-added reports with the data insights you want.

Four ways to strengthen your practice

Strategies to help provider groups maintain independence, support long-term stability and drive success.

Payer-provider collaboration: Improving patient outcomes

Tech and value-based care can improve payer-provider collaboration, reduce admin burden and enhance patient outcomes through data sharing.

Trends for health plan quality performance

Learn how health plans can stay ahead of the curve and prepare for key trends likely to impact their quality programs in 2025 and beyond.

Exploring possibilities cdi metrics

Watch the panel-style webinar with Banner Health CDI and analytics leaders to discuss business intelligence analytics and health information management.

Provider report cards help emergency medicine groups

Learn more about how provider report cards can help emergency medicine groups thrive.

VBC 5.0: Mastering the 5 pillars of value-based care success

Explore the 5 pillars of value-based care every health system, health plan and provider needs to succeed.

Improving the provider experience

Learn about a modern and proactive approach to payment integrity for health plans.

Transforming maternal health: A roadmap for states

We offer analytics, consulting insights and real-world application for states to improve maternal health care for women enrolled in Medicaid.

Utilizing patient access contact center

See how a hospital streamlined scheduling for about 700 providers and strengthened customer service for over 65,000 patient calls monthly.

Rethinking the healthcare payment process

Explore ways to create a more seamless and transparent payment experience for healthcare consumers.

Engaging and transforming patient experiences

Healthcare leaders share strategies to improve patient outcomes by addressing friction points, emphasizing empathy and valuing staff.

Navigating AI in Healthcare

Watch this on-demand webinar for expert insights on AI capabilities, business challenges and robust governance in healthcare.

Using clinical intelligence for revenue cycle

Our white paper shows how investing in smart technologies, such as clinical intelligence, supports the revenue cycle from patient registration through full reimbursement.

Advancing dme benefits management

Learn how DME Navigator can help streamline durable medical equipment (DME) benefits management. 

Beyond the hype: Real AI use cases to drive payment accuracy

Explore real use cases for using AI to drive payment accuracy and the effective ways health plans are leveraging these emerging technologies.

Optum recognized as RCM market-defining leader

We're proud to be recognized as the Frost Radar™ Revenue Cycle Management Operations 2025 growth and innovation leader.

The Future of Autonomous Medical Coding

Insights from an expert coding panel.

Going Beyond Risk Adjustment in Provider Engagement

Learn innovative techniques for risk adjustment workflows that help emphasize pre-visit chart prep and clinical suspect identification.

A beginner’s guide to implementing risk adjustment coding

This guide for provider groups outlines a 3-step process to build a robust coding program that supports improved value-based care outcomes.

Value dex z codes

Optum and Palmetto experts partner in discussing how to solve genetic lab challenges in legacy solutions.

Re-examining radiology with Optum

Explore the transformative changes happening in the field of radiology and their impact on advancing healthcare.

HouseCalls: Reach members where they are

Help manage members’ health through in-home or virtual assessments.

How cloud-native PACS transformed a rural hospital

In this case study, learn how cloud-native technology can unlock efficiency.

The missing link to risk adjustment success

Discover how program orchestration helps health plans align systems, vendors and strategies amid regulatory and financial pressures.

Explore our AI-enabled radiology portfolio

Learn how our Radiology Solutions use AI to rapidly identify relevant radiology images.

The ASAM Criteria® Navigator, 4th edition

Learn how to streamline efficiency and consistency of the utilization review process.

Enterprise imaging cloud strategy webinar

Learn about the differences between “cloud-based” and “cloud-native” image hosting.

Hospital employed anesthesiologists and RCM

Dive deeper into the market shift transforming the modern anesthesia employment market.

Automating success: A smarter path to revenue cycle transformation

Learn how health systems are using revenue cycle automation to provide better patient experience, financial outcomes and operational resilience.

What health plans need to know about provider usage of AI

Uncover the 4 major ways providers are leveraging AI and how this trend is changing payment integrity for health plans.

Why risk adjustment is critical for the success of ACOs 

Learn how ACOs can leverage risk adjustment to enhance provider engagement, compliance and patient equity in care delivery

Developing Medicaid Core Set measures for States

Discover how Michigan and Virginia took different approaches to meet the federal mandate of tracking care quality for Medicaid and CHIP.

Member engagement: Advancing whole-person care

By collaborating with health plans and their members, Optum helps build a more cohesive, supportive system that prioritizes member needs.

Integrated risk and quality programs: A strategic approach

Unlock new efficiencies with a digital-first, AI-powered approach to empower value-based care and enhance health plan performance.

Engage providers impact member outcomes

Download our infographic to learn how Optum can take the burden off payers to impact provider performance.

Cyberthreat webinar

Learn practical steps you can take to safeguard your enterprise imaging data.

Establish renewed priority on revenue loss

In volume 2 of this white paper, discover 3 strategies to improve revenue performance from proper levels of reimbursement to writing off bad debt and expanding into new service areas.

Five step InterQual evidence-based development process

The InterQual Criteria is developed through a rigorous, five-step process by our clinical development team.

Unlock the future of risk and quality in healthcare

Discover how Optum is helping revolutionize the healthcare industry with innovative solutions in risk adjustment, quality improvement and member engagement.

Unlocking new possibilities in risk adjustment

Learn how Optum helps health plans improve performance by using data, AI and smart technology to enhance accuracy, efficiency and integration.

The future of payment integrity

Unpack key trends shaping the future of payment integrity and discover steps you can take to get started on your path to payment precision.

Navigating the challenges of outpatient evaluation for patients with acute coronary syndrome

Learn how the InterQual level of care team tackled a content development challenge following updated societal guidelines for acute coronary syndrome.

Improve efficiency with Optum CAC and CDI 3D

See how one health system partnered with Optum to transform their coding and CDI program.

Transforming payer operations with Steve Yurjevich

Optum payer market CEO Steve Yurjevich discusses opportunities to streamline operations and deliver more value across the health system.

Choosing an accounts receivable partner

Selecting a strategic accounts receivable partner requires careful evaluation.

Business intelligence delivers financial insights lab

Learn how BI can improve operational performance, provide access to key financial indicators and support compliance.

The new AI approach to eliminating contract-based errors

Learn how we're leveraging AI to help minimize payment errors associated with manual contract reviews.  

Buck denial trends

Learn about the latest national denial trends to help you avoid rework and future denials.

The benefits of microservice imaging architecture

Our cloud-native solutions use dynamic load balancing to optimize resource use across all applications.

Engaging specialists in value-based care

Alternate payment methods (APMs) can boost quality and cut costs by aligning payment and delivery for specialist providers.

Future of prior authorizations: Automation, integration and results

Discover how the right technology partner paired with deep EHR integration and workflow alignment can transform your prior authorization process.

RCM services allow laboratory navigate difficult waters

Learn how Optum implemented comprehensive revenue cycle management procedures to help Meridian Laboratory Physicians bill for clinical pathology, increase reimbursement and support practice growth.

Patient education: The secret to success in risk adjustment and VBC

Effective patient education fosters adherence to medical treatments and promotes healthy patient behaviors, in turn facilitating successful risk adjustment and value-based care.

The AI technology transforming imaging

Learn how artificial intelligence (AI) can support patient care, improve workflows and more.

Your guide to digital quality measurement in 2026

The $20 billion opportunity in healthcare automation  

Discover how the final shift to electronic transactions can save billions and transform healthcare operations.

Rethinking quality in the digital frontier

Learn about NCQA’s shift to digital quality reporting and how Optum can help your organization stay ahead.

Find immediate ROI with cloud-native enterprise imaging

Learn how artificial intelligence (AI) can support patient care, improve workflows and more.

Seamless image sharing for better care coordination

See how a large health system improved care coordination and patient experience with Change Healthcare Stratus Imaging Share.

Maximize OR efficiency with predictive analytics

Learn how to use AI-enabled recommendations to optimize surgical capacity and predictive analytics to forecast future block utilization.

NASPO ValuePoint streamlines procurement

Streamline enrollment and admin activities with the Optum Provider Services Module, a self-service gateway for Medicaid providers and agency staff.

Optimizing patient care through point-of-care decision support

Discover how evidence-based technology can enable smarter clinical decision making.

3 pillars of physician revenue cycle management

How cultivating a combination of people, processes and technology is a critical driver of RCM success.

5 AI use cases in payment integrity

A strategic blueprint to modernize your payment integrity program through intelligent, AI-driven health plan operations.

Dashboard streamlines Medicaid SUD program

Virginia’s new Medicaid analytics dashboard centralizes SUD data, improving treatment strategies and reporting for vulnerable communities.

Streamlining DME with accuracy and efficiency

Explore how health plans can streamline their DME process to deliver a seamless, connected experience that enhances the payer experience.

From data collection to intervention

Learn how you can leverage analytics to address social determinants of health.

Reducing administrative variation with artificial intelligence

Infuse technology into your medical necessity process.

Unlock the full potential of your payment integrity office

Discover the 5 key components of a high-performing payment integrity program. Build a structure that helps optimize savings.

Understanding the transition to cloud-native imaging

Imaging center uses cloud-native technology to future-proof operations.

The No Surprises Act

Get an overview of the Act with recommendations for physician practices.

The future of payment integrity in healthcare

iscover how Optum is contributing to the transformation of the healthcare industry with innovative solutions in payment integrity.

The criticality of evidence-based medicine

Evidence-based medicine improves quality of care while reducing the cost of care.

Data collection for risk adjustment compliance

Learn the 4 core pillars of a strong data collection process — a strategic imperative for improving healthcare outcomes. 

Revolutionizing prior authorization solutions

Improving hospital quality and utilization

Learn how data insights helped 4 organizations transform their operations.

Extracting value-based care insights from claims data

We provide actionable insights for health plans and providers to adopt a data-driven approach and achieve value-based care goals.

Best practices utilization review

Learn best practices of utilization review to help your health system maintain clinical, compliance and revenue integrity.

Volume 1: Better financial health and improved operations

Read the white paper for strategies on controlling fixed costs, efficiency and organizational flexibility.

Pharmacogenomics in medication selection

Enable more effective and targeted treatments that address unique needs for patients with pharmacogenomics.

5 building blocks for an effective member engagement strategy

Learn how to build a holistic engagement strategy to help improve member satisfaction and better achieve your goals.

Middle RCM tech

Artificial intelligence (AI) and automation are having a major impact on improving the middle RCM for healthcare providers.

RCM essentials for 2025

From process re-design to automation with advanced technology, learn how healthcare finance leaders optimize their RCM operations for the future.

Transform your risk adjustment strategy

A strategic risk adjustment analytics framework guide for health plans.

Maximize digital mammography reading efficiency

Learn how an all-in-one workstation for mammography and radiology increased study volume and accelerated turnaround.

Help enhance coding accuracy with the HCC Tearsheet 2025

Accurate HCC codes are essential for effective care management and compliance.

The role of imaging decision support in VBC

See how tools like CareSelect® Imaging can help providers enhance clinical decision-making, improve patient outcomes and reduce administrative burden.

The cost of inaccurate data: An overview of risk adjustment audits 

As CMS moves to increase RADV audits, payers must understand the implications of RADV and find the right support for a smooth audit process

What to know about managing rising transplant costs

What payers need to know about transplants and other high-cost care.

Empowering providers with AI innovation

Generative AI is reshaping healthcare — boosting efficiency, easing documentation and empowering providers across the system.

AI in action: Practical use cases for state health programs

AI transforms state health programs by automating detection, strengthening oversight and driving impact. Get key insights from experts.

Leveraging data-driven heat maps

The Optum network gives transparency to customized potential connections, helping boost revenue.

Trends shaping the future of payment integrity

Explore the market trends that are shaping the future of payment integrity and learn what they will mean for health plans.

Level up your surgical savings

Discover game-style strategies and real-world case studies for reducing surgical costs and standardizing supply use with Crimson AI.

AI-powered study prioritization

Read our case study.

Guide to achieving seamless digital integration

Optum offers digital solutions in 3 key areas: data acquisition, insight sharing and enhanced functionality.

Rising expectations among health care consumers

Learn about the growing expectations people have for their healthcare experience and how to improve the consumer journey.

Reimagining fraud prevention

Find out how modernization of emergency relief programs can detect and prevent fraud.

Strengthen ED visit-level determinations with these key elements

Learn how to strengthen your ED visit-level determinations, and identify areas for improvement.

The benefits of outsourcing medical billing

Discover a step-by-step strategy for gaining administrative buy-in.

Building a connected care model

People feel the disconnect of a siloed healthcare system. Get insights on how to build more holistic care through connected care models.

Everest Group guide to selecting RCM services

Buyer’s guide helps hospital leaders evaluate and select RCM services partners with the future in mind.

Risk adjustment Star ratings success

Discover 5 strategies that will help your health plan be prepared to factor risk adjustment data into Star Ratings.

Cloud-based upgrades

Learn how cloud-based imaging solutions can speed upgrades and reduce maintenance.

Beyond the pitch: How to evaluate AI vendors with clinical confidence

Learn what to look for in an AI healthcare partner — from clinical rigor to transparency — to support safe, effective implementation.

Change Healthcare Stratus Imaging Share

Learn how much you could save by eliminating CD burning.

Inventory management solutions made simple

Discover inventory management solutions that guide the decision-making process for efficiency gains, better practices, cost savings and safer care delivery.

Optimizing physician reimbursement

Learn how physician groups can leverage automation and incorporate advanced analytics to help ensure they’re collecting every dollar.

The road to modernization: What’s next for your contact center?

Today’s constituents and stakeholders expect to interact with state agencies quickly, effortlessly and through their preferred communication channel.

Reduce risk and capture lost revenue

Learn how Change Healthcare Imaging Actionable Findings can help, solve complex care needs.

Consumer centric health care research report

Examine the acceleration toward consumer-centric care with insights and perspective from healthcare leaders.

Change Healthcare Workflow Intelligence

Learn about our vendor neutral, flexible medical imaging workflow rules engine.

We follow the science and defend against bias

See how Optum follows the science where it leads, validating the research we find to uphold the clinical integrity of InterQual content.

Payer-provider interoperability to enhance prospective risk management

Payers and providers are using advanced technology in healthcare to create efficient processes that capture chronic conditions and deliver better health outcomes .

How AI is transforming hospital utilization management

In the landscape of hospital utilization management, effectively applying AI and automation is essential to achieving meaningful results.

Benefits of artificial intelligence reach the revenue cycle

The use of NLP makes the revenue cycle work smarter, not harder.

Coding audits: Why and how to do them

Discover how regular coding audits can streamline audit and compliance efforts, boost hospital reimbursements, and improve patient financial experiences.

Achieving equitable care: The shift to race-neutral equations

Discover how the InterQual team facilitated the timely adoption of new industry guidance for improving health outcomes in clinical practice.

Can a holistic approach help with UM challenges?

Learn how acute care organizations can address UM challenges with a holistic, comprehensive approach.

The HouseCalls difference: Kim's story

Kim, a HouseCalls advanced clinician practitioner, believes a good day is when she’s helped someone. Watch the video to see her story.

Simplifying provider engagement for health plans

See how Optum can help your providers deliver coordinated, high-quality care for patients.

Streamlining real-time eligibility and claims

Discover how real-time eligibility, benefits and claim status inquiries can improve accuracy and efficiencies for payers and providers.

Intelligent workflow case study

Learn how intelligent workflow can help improve efficiency and patient care.

Emerging trends impacting payment integrity

We take a look at how market shifts, AI innovation and cost pressures are redefining health plan strategies.

6 workforce strategies for healthcare leaders

Strengthen and inspire your healthcare workforce. Our actionable toolkit offers new strategies to reconnect with talent, simplify workflows and more.

Cloud PACS helps ensure continuity

Cloud-native Stratus Imaging PACS by Optum helped CIRA restore patient care, reading 7,000 exams in days during a cyber incident.

Analytics answer compliant coverage identification

Using advanced analytics and rich data resources can help boost providers’ ability to screen the self-pay patient.

The state of risk adjustment, quality programs and value-based care

Learn what insights we discovered by partnering with Frost & Sullivan on a benchmarking survey of payers and providers.

Clinical exchange eprescribe self service tool speeds enrollment

Healthcare systems need new systems to better facilitate enrollment despite staffing shortfalls.

Causes of medical necessity denials

Learn two critical indicators causing these denials, and how to account for them effectively.

A proven path to stable, reliable, scalable modernization

Learn how a more than 10-year collaboration led to a seamless enrollment experience in 2025 for millions of consumers in Medicaid and QHP plans.

Improve medicaid risk adjustment accuracy

Explore Medicaid best practices for health plans and learn three actions to take and when to take them.

Making cardiovascular data work for the future

What can technology leaders do today to facilitate future advancements in cardiovascular data and analytics?

A single database cardiology platform that drives efficient workflow

Read our case study.

Risk adjustment solutions: The impact of medical innovations

Explore the influence of key innovations on risk adjustment solutions. Learn how these technologies are shaping the future of healthcare.

Five ways to improve your cardiovascular workflow

Learn how to improve productivity with a workflow solution that innovates in five key areas.

Health leaders share IT transformation stories

Hear John Muir Health and Bassett Health’s observations on digital transformation, modernizing infrastructure and strategic automation.

Innovating risk adjustment strategies

Read this blog to learn how Renown Medical Group empowers clinicians and improves patient outcomes.

Analytics in action: Building a strategic framework for risk adjustment 

Explore how to harness the power of analytics to shape your 2026 risk adjustment strategy.

A beginner’s guide to risk adjustment analytics for providers

Learn how you can implement advanced analytics at your provider organization with our 7-step guide.

Driving innovation with new revenue cycle services

One organization decreased uncompensated care, increased loyalty and patient satisfaction, and connected patients with more funding sources.

EPCS mandates state interactive map

Discover an interactive EPCS mandate map providers can use to track where and when mandates are happening in each U.S. state.

How to transform imaging with behavioral science

Behavioral science is being applied to unique methods of enterprise imaging product design.

The perfect blend: AI and human validation in condition capture

In the ever-evolving landscape of healthcare, the need for complete and accurate risk adjustment has never been more critical.

Optum a leader in GenAI payer workflow platforms

Optum has been recognized with a Product Leadership Recognition in the North America GenAI payer workflow platform industry by Frost & Sullivan.

Move your enterprise imaging to the cloud

Learn how to highlight the immediate cost and efficiency gains of cloud adoption.

Four steps to smarter provider education

Discover how health plans can reduce billing errors and strengthen provider relationships through AI-enabled proactive education.

Key data insights for your hospital services strategy

Unlock the power of pharmacogenomics with Optum® Precision Script

Integrate PGx data into pharmacy claims to support safer prescribing, smarter medication management and better patient outcomes.

Solutions to simplify Medicare compliance

Discover solutions that help you efficiently and consistently comply with CMS-4201 and CMS-0057 requirements.

Spend more time with members

See how prospective assessment programs can reduce administrative burden. Physicians spend less time on paperwork, so they can focus on what matters most: member care.

Clinical exchange eprescribe enhances care delivery

Streamline workflow and increase accuracy with Clinical Exchange ePrescribe and Surescripts Real-Time Prescription Benefits.

Automating success revenue cycle transformation

Set the foundation for synchronized and connected revenue cycle management.

Streamline Medicaid eligibility and enrollment processes

The rise of healthcare consumerism has prompted many hospitals and health systems to rethink their patient satisfaction strategies.

Social Care Assistance helps member assessment

Optum helps health plans address member needs through screening and community-based organization (CBO) referral services.

Key learnings for modernizing your state’s legacy system

Dr. Garry Choy, CMO, discusses the pros and cons of using automation and clinical decision support to meet today’s workforce challenges.

Bassett Healthcare network blazes bold path forward

Optum helped Bassett achieve independence and financial resilience while maintaining outstanding care delivery. See how the partnership came together.

Coding modernization: Leveraging the power of AI

Learn how Optum takes an innovative approach to smarter, more accurate healthcare coding.

Strategic planning for imaging in the cloud

Learn what health IT and imaging leaders need to do before moving their enterprise medical imaging to the cloud.

Webinar: Trends and challenges in telehealth

Explore new ways of doing business that allow you to meet shifting customer expectations, workforce challenges and emerging business goals.

Bassett Healthcare partnering insights

Tommy Ibrahim, MD, CEO of Bassett Healthcare Network, shares insights on reinventing a health system for success.

Quality innovation: A member-first approach

Learn how Optum uses a member-first digital approach, advanced analytics and AI to enhance quality for clients and health plan members.

Creating a seamless durable medical equipment experience

Discover how a digital-first DME strategy can enhance efficiency and transparency for health plans, clinicians and members.

Best practices for efficient medical record retrieval

Medical record retrieval is an essential task for healthcare providers and insurers, but it can often be a complex and time-consuming process.

Site-of-care decisions: Navigating safety, access and value

Learn about benefits and challenges of the site-of-care shift and how InterQual Site of Service helps organizations navigate the transition.

Using behavioral science to inform hemodynamics product design

Learn how behavioral science can improve the hemodynamics solution in vital ways for physicians and technicians.

Enterprise transformation services

Health systems continue to face many challenges. Do you have the flexibility and focus to deliver on strategic goals or transform your business?

Steps to smarter prior authorization

Healthcare organizations face challenges with prior authorization. Learn how automation can help save resources and improve patient care.

Developing evidence-based tools for accessible and quality care

Explore how evidence-based tools like The ASAM Criteria® Navigator and InterQual® Substance Use Disorders Criteria are helping payers and providers efficiently and effectively navigate the complex substance use disorder landscape today.

Optum is the leader in payer-provider collaboration

Optum has been named the market leader in the Frost Radar™: Healthcare Payer-Provider Collaboration Solutions in North America report by Frost & Sullivan. 

Digital integration and the path to interoperability

Creating a connected system to improve risk and quality outcomes.

Five priorities improve financial performance

This E-book will help you master five fundamentals for a sound financial future.

Migrate your enterprise imaging to the cloud

Watch our webinar on migrating your enterprise imaging to the cloud.

Helping emergency services practice streamline accounting

A busy emergency services practice gets help to ensure its financial health and allow physicians more time and confidence to do their jobs.

Promises and pitfalls: AI and clinical decision-making

Learn more about why evidence-based criteria and clinician insight are needed for informed and trustworthy decisions while leveraging AI.

Innovative approaches to collaborate with PCPs

Understanding the challenges confronting Medicare Advantage plans and their Medical Loss Ratio.

Transparency helps medicaid providers

See how technology can be used to reduce complexity, administrative rework and improper claims denials. 

Boulder Community Health and Optum

Optum partnership insights and strategies enable near- and long-term success for provider organizations.

Key considerations when updating provider management modules

Explore 6 key factors when updating, streamlining and coordinating provider management modules with other Medicaid functions.

Filling revenue cycle resource shortfalls

Learn how to identify and overcome common revenue cycle challenges despite current labor market issues.

Transforming CDI and coding with advanced analytics

Banner Health partnered with Optum to pair AI-powered technology with advanced analytics, enabling an expanded focus on quality and risk-adjustment initiatives.

The impact of AI on value-based care

Learn 7 ways artificial intelligence is changing the game in healthcare.

The future of quality reporting

Learn how AI, interoperability and ECDS are transforming healthcare quality reporting and the solutions that can help you stay ahead.

Exploring the evolving landscape of autonomous coding

This panel will address autonomous coding trends, challenges and innovations within the middle revenue cycle.

Smart revenue cycle investments

These two targeted investments will strengthen your revenue performance more than deep cost cutting.

7 key trends in risk adjustment

Examine the trends reshaping risk adjustment and learn how your organization can stay ahead in 2026.

Create a expert-level front-end revenue cycle

Learn six ways to take your operations from good to great.

Clinical Exchange Orders and Results tool

Streamline the implementation process of healthcare lab operations and enhance enrollment control with our self-service tool.

Empowering providers to focus on patient care

Our provider performance team partners with your providers to reduce administrative burden and drive positive patient outcomes.

Aligning with CMS: Medicare Content Navigator and InterQual Transparency

Discover how to meet the latest regulatory requirements for Medicare Advantage plans.

The fight for techquity

Get ideas for how to fundamentally change your approach to building technology and incorporate techquity into your organization.

Preserving talent and enabling career growth insights

The Optum Market Performance Partnership is designed to help health systems achieve strategic, operational outcomes while preserving talent.

Risk adjustment coding 101 for providers

Learn actionable strategies and best practices for effective implementation of coding programs for provider organizations.

Innovation Without Compromise: Navigating Faster Turnaround Times with Responsible AI

Discover what to ask AI vendors and how to build a strategy that supports accelerated decision-making, reduces administrative burden and maintains clinical integrity.

Revenue cycle ripple effect

Streamline your patient experience, enhance satisfaction, reduce costs and improve your financial performance with our digital tools.

Strategies for centering patients and staff

Learn how to help transform hospital revenue cycle operations with healthcare automation.

"No regret" IT investments

Learn which tech investments can benefit providers most today.

Continuous insurance coverage discovery

Learn how our two-stage approach to eligibility coverage links pre- and post-service analysis in near real time.

Navigating the future of addiction treatment with The ASAM Criteria® Fourth Edition

Explore the development of The ASAM Criteria® Fourth Edition and discover tools and programs available to support your transition.

Bronson's cloud imaging archive journey

Bronson Healthcare transitioned to a cloud-native imaging archive, reducing administrative burden, improving system speed and enhancing provider and patient experience.

Help your bottom line through UM optimization

An efficient utilization management (UM) program is a must to deliver high-quality patient care while managing costs.

Diagnose the health of your health plan

Learn 8 advantages of an end-to-end risk adjustment platform.

Break down silos in claims processing

Fragmented payer-provider communication fuels denials, delays and rework. Learn how real-time insight can help address root causes earlier in the claims process.

Improve price transparency

Deliver a better patient experience through price transparency.

Automate your front office to address the staff pinch

Learn how automating appointment scheduling, eligibility verification and communications, and more eases pressure on staff.

Transforming care through payer-provider collaboration

Discover the key elements to creating a positive, mutually beneficial relationship.

Improving performance at Excel Medical Center

Empower provider success and improve member care through digital integration.

Innovations in contact center efficiency

Hear from our experts as they discuss the role of AI and other trends in a well-connected system.

Boulder community health partners employee success

Explore how Boulder Community Health partnered with Optum to continue elevating its most critical component of success — its workforce.

How the revenue cycle and leaders are evolving

Find out how to shift your revenue cycle left, focusing on front-end revenue cycle management (RCM) capabilities.

The costs and benefits of cloud-based imaging

Understand the seen and unseen costs of migrating your enterprise imaging to the cloud.

Reduce length of stay and enhance resource efficiency

Learn more about how Crimson AI enables best practices for achieving operational excellence.

From concern to confidence: Modernizing for a smarter, stronger, and future-ready state exchange

Optum transformed a troubled health exchange, reducing incidents by 90% and improving enrollment accuracy, ensuring a smoother experience for all.

Reprioritizing growth: Differentiate and deliver

Learn about nuanced growth strategies focusing on service differentiation, targeted patient acquisition and integrated care delivery.

Denials index

Learn about the latest trends in medical claim denials and find out how to decrease them.

Fire department boost collections forty percent

Our case study shows how the Cincinnati Fire Department recovered missing revenue with Optum billing and collection systems.

Maintain operational and financial viability

Read this white paper to learn strategies that can help critical access and independent hospitals remain viable in their communities.

Data-driven AI for RCM transformation

AI and clean data are helping change healthcare for the better. Discover how teamwork and smart tech can help payers and providers work together.

Navigating the complexities of healthcare automation

Learn how to assess your organization’s readiness for automation. Get strategies to unlock the full potential of your automation investments.

The keys to revenue cycle transformation

Gain expert insights into strategies to decrease costs, unlock new sources of growth and improve patient experiences.

Developing an industry-leading middle revenue cycle for hospitals

Explore the six focus areas for improving performance to create an industry-leading middle revenue cycle for your hospital.

4 steps to optimizing value-based care

Learn how combining these steps can help power a holistic workflow between payers and care delivery.

Optimizing UM with InterQual AutoReview

An Optum expert explains how hospital systems can transform their UM programs and drive efficiency with InterQual AutoReview.

A forward approach to medical coding accuracy

Our coding software can systemize aspects of your middle revenue cycle, resulting in a seamless and cost-effective workflow.

What healthcare leaders really think about AI

For our 2-part series on the future of AI, we surveyed more than 100 healthcare leaders. Part 1 reveals how leaders are approaching AI investments. Part 2 looks at the leadership challenge that executives face.

Establishing trust to improve value-based care outcomes

Gain insights into how supporting providers can help increase engagement and reduce administration burden for better patient care.

Adapting to the changes in Medicaid policies

The upcoming changes to Medicaid policies are set to significantly impact organizational operations.

Outsourcing medicaid eligibility enrollment

Discover how one client outsourced Medicaid eligibility and enrollment to drive patient satisfaction and higher reimbursement levels.

Navigating growth in the healthcare industry

Learn how to overcome challenges and achieve scalability with your medical practice.

10 hurdles to reimbursement

Focus on the specific hurdles that hinder your claims and cause most of your denials. We'll walk you through how to clear each obstacle.

Navigating the pandemic

Learn how Optum revenue cycle management services helped Santa Fe Pathology Services maintain financial stability throughout the COVID-19 crisis and position the practice for growth.

How AI accelerates workflows and patient cancer care

Discover the potential of AI and how it helps save thousands of lives each year.