Optum360 offers physician advisor expertise, evidence-based medical research and sophisticated artificial intelligence (AI) technology to support appropriate reimbursement and accurate documentation.
We team up with your physicians to pinpoint improvement opportunities. Choose from services, technology or a combination of both to fit your needs.
Our on-site and remote services can apply AI to drive timely patient-status determinations. We deliver greater efficiency, accuracy and integrity to your utilization review process and outcomes.
Our Physician Advisor Services and our Case Advisor™ technology can help you reduce denial rates, improve appropriate reimbursement and minimize audit risk. Our technology can help your internally sourced physician advisors become more effective and efficient.
Improve your acceptance rate
Our medical necessity recommendations acceptance rate is 91%*
Use evidence-based guidelines
20,000+ medical research articles back up recommendations
Tap 20+ years of experience
We’ve conducted 14M+ medical necessity reviews
Revolutionizing utilization review with artificial intelligence
Traditional utilization review (UR) processes can be slow and error-prone. Learn how Optum360 is leveraging the power of AI to revolutionize UR for greater efficiency, accuracy, and more appropriate use of clinical resources.
Using a hybrid physician advisor program
Central Florida Health Alliance tried to insource its second-level medical necessity review process, but it was more challenging than anticipated. Hear how Saad Ehtisham, chief operating officer, turned to Optum360 On-Site Physician Advisors for their admission review needs.
* For dates Jan-April 2018. Assuming cases that were not appealed by Optum were all billed and accepted as Optum recommended.