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Revolutionizing Utilization Review

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Optum360 offers physician advisor expertise, evidence-based medical research and artificial intelligence to support appropriate reimbursement and accurate quality reporting within your organization. We team up with your physicians to pinpoint improvement opportunities.

Our on-site and remote services can apply artificial intelligence to drive timely patient-status determinations. We deliver greater efficiency, accuracy and integrity to your utilization review and clinical documentation improvement processes and outcomes.

Our Physician Advisor Solutions can help you reduce denial rates, manage appeals, minimize audit risk and optimize reimbursement.

 

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Value of the AI-powered service model

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clinical overview
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Effective use of clinical resources

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emotional health
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A smarter, holistic UR process for comprehensive caseload review

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Predictive insights for improved status accuracy 

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reimbursement
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Improved Optum360 investment value

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Are you ready to join the revolution?

  • Proper review of all cases
  • Reduce denials
  • Achieve appropriate reimbursement
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improvement on patient status accuracy

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estimated annualized proper reimbursement improvement

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in denial rates

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The changing role of case managers

A wide range of responsibilities is straining old case management models and requires new, disruptive approaches to help providers achieve sustainability.

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See one way case management teams can adapt to succeed at this increased role with our new infographic.

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Our new AI-powered model

See how we use AI to power our new service model.

The evolving role of utilization review

Explore the challenges of utilization review and strategies to achieve proper reimbursement.

Addressing Commercial Denials

Address your commercial denials with a clinical perspective.

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Optum Physician Advisor Solutions

Learn about all of our physician advisor services.

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AHIMA19 Health Data and Information Conference

September 14 - 18 | Chicago, IL

Visit AHIMA Website

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Start the conversation

The path to a denial-free future is possible with the right partner. Our flexible engagement model can adjust to match your organizational needs.

Contact us online

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