Using real-time data and AI, core processes are becoming faster and more transparent, Optum says.
Optum Real, a real-time claims system that instantly connects payers and providers, has partnered with Microsoft to speed the claims and reimbursement process.
The partnership combines Optum’s healthcare and AI expertise with Microsoft’s cloud and AI technologies, including Microsoft Azure, Microsoft Dragon Copilot, and Microsoft Foundry.
Simplifying the claims and reimbursement processes is expected to reduce the administrative burden for clinicians.
WHY THIS MATTERS
The collaboration introduces new provider-focused capabilities within Optum Real.
This includes smarter coverage predictions that reduce manual work for coders and help clinicians reach recommendations faster; AI-powered documentation and chart intelligence; and AI-assisted support for prior authorization that surfaces potential coverage and payment issues earlier, according to Optum.
For providers, this results in unified clinical and operational data. Patients get visibility into their coverage and clearer billing before they leave the doctor’s office, according to Optum.
Optum Real pilot programs have cut avoidable denials by up to 80%, reduced call volume by 25%, and eliminated as much as 75% of reimbursement errors, according to Optum.
“Providers are overwhelmed by disconnected systems and manual processes that take time away from patients,” said Kristie Richardson, chief product and services officer at Optum Insight. “Optum Real, and our collaboration with Microsoft, is about solving these pain points at scale, bringing together deep subject matter expertise, trusted cloud and AI technology, and an ecosystem perspective to deliver real, measurable impact.”
Larry Jones, CVP, health and life sciences, Microsoft said, “By creating a powerful, real-time engine for coverage validation, documentation, and prior authorization, it is more than modernizing claims–it’s about building a more transparent, efficient, and trusted health care experience for everyone.”
THE LARGER TREND
As global healthcare spending approaches $10 trillion by 2026, modernizing claims and reducing administrative waste is essential to improving affordability, Optum said.
The more efficient processes are also coming at a time when the Centers for Medicare and Medicaid Services is mandating faster prior authorization decisions.
In 2024, CMS released an Interoperability and Prior Authorization Final Rule. Starting this past January, payers have been required to send prior authorization decisions within 72 hours for urgent requests and seven calendar days for standard requests.
Starting on Jan. 1, 2027, the rule requires payers to meet application programming interface (API) mandates for patient and provider access and data exchange.
In February Optum introduced AI-powered prior authorization for automated decisions that it said reduces delays, speeds approvals and reduces repetitive work.
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