(Bloomberg) --UnitedHealth Group Inc. is testing a new system to streamline how medical claims are processed, an early example of what the company says is the potential for artificial intelligence to smooth out friction in billing.
The system, dubbed Optum Real, aims to distill health plans' complex rules around what is covered into information that doctors and billing staff can use in real time to tell whether a claim is likely to be paid.
It's been in place at Allina Health, a 12-hospital system based in Minneapolis, since March, where two departments have used it to connect to UnitedHealthcare, the health conglomerate's insurance division. It's already reduced claims denials meaningfully across more than 5,000 visits in Allina's outpatient cardiology and radiology departments, said
Proponents of AI tout its promise to cut waste and inefficiency by automating tedious manual tasks. The US health system is a prime candidate. Providers and health plans employ armies of back-office staff to handle claims processing, prior authorizations and disputes over billing. They spend about
Read More:
Optum Real is speeding up prior authorization requests and helping some patients get care faster, Allina Health's Ingham said. It's also reducing headaches for billing and coding staff by flagging claims that need more documentation, for example, before they're denied. That lets Allina fix the problem without a lengthy back-and-forth with the insurer.
"We avoid that disappointment, that frustration with the clinicians and the patient of having that denial experience," he said in an interview. "It's less paperwork on both sides."
The system is from UnitedHealth's Optum Insight unit, which already sells software and services to both health plans and medical providers aimed at handling prior authorizations, denials and other administrative hurdles. UnitedHealthcare is the only health insurance company involved so far, but Optum Insight Chief Executive Officer Sandeep Dadlani said the goal is to get more insurers and providers to join the system as they seek to benefit from lower transaction costs.
"This sort of positive vortex should help us create critical mass," Dadlani said.
Optum isn't charging a fee for providers and insurers to connect to the core Optum Real functions, Dadlani said. The company will make money by helping both sides digitize the information needed to plug into the system, then selling premium features like advanced analytics that can run on top of the platform, he said.
The company has 10,000 AI engineers, Dadlani said, and views Optum Real as the first of several technology platforms that "perhaps transform or begin to transform health care as we had hoped in this AI powered world."
