List of Optum CES Customers
Eden Prairie, 55344, MN,
United States
Since 2010, our global team of researchers has been studying Optum CES customers around the world, aggregating massive amounts of data points that form the basis of our forecast assumptions and perhaps the rise and fall of certain vendors and their products on a quarterly basis.
Each quarter our research team identifies companies that have purchased Optum CES for Payment Integrity from public (Press Releases, Customer References, Testimonials, Case Studies and Success Stories) and proprietary sources, including the customer size, industry, location, implementation status, partner involvement, LOB Key Stakeholders and related IT decision-makers contact details.
Companies using Optum CES for Payment Integrity include: Metropolitan Jewish Health System, a United States based Healthcare organisation with 2000 employees and revenues of $450.0 million, ATRIO Health Plans, a United States based Insurance organisation with 140 employees and revenues of $25.0 million and many others.
Contact us if you need a completed and verified list of companies using Optum CES, including the breakdown by industry (21 Verticals), Geography (Region, Country, State, City), Company Size (Revenue, Employees, Asset) and related IT Decision Makers, Key Stakeholders, business and technology executives responsible for the software purchases.
The Optum CES customer wins are being incorporated in our Enterprise Applications Buyer Insight and Technographics Customer Database which has over 100 data fields that detail company usage of software systems and their digital transformation initiatives. Apps Run The World wants to become your No. 1 technographic data source!
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| Logo | Customer | Industry | Empl. | Revenue | Country | Vendor | Application | Category | When | SI | Insight |
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ATRIO Health Plans | Insurance | 140 | $25M | United States | Optum | Optum CES | Payment Integrity | 2020 | n/a |
In 2020, ATRIO Health Plans implemented Optum CES to support Payment Integrity. The deployment focused on establishing configuration controls for provider and contract data to reinforce claims payment integrity workflows across ATRIO Health Plans operations in the United States.
Implementation work centered on Optum CES provider configuration, contract configuration, fee schedule configuration, and benefit configuration modules, with a Configuration Manager role responsible for rule definition, fee schedule setup, and provider network parameterization. The Configuration Manager skills highlighted by the source emphasize hands-on system parameterization and master data configuration within Optum CES.
Governance activities included role-based ownership of configuration artifacts, formal control over fee schedule and contract rule changes, and alignment of those controls with payment integrity processes. The implementation tied Optum CES configuration to business functions including claims payment integrity and provider data management, reinforcing operational controls around contract compliance and fee schedule enforcement.
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Metropolitan Jewish Health System | Healthcare | 2000 | $450M | United States | Optum | Optum CES | Payment Integrity | 2014 | n/a |
In 2014, Metropolitan Jewish Health System implemented Optum CES to strengthen Payment Integrity across claims processing. The rollout was centered on the claims operations organization, supervising two claims supervisors and twenty staff members, and aligned with departmental controls for claims adjudication and payment output.
Optum CES and Optum iCES configuration work focused on Health Rules configuration and business rule sets for claims adjudication, including explicit configuration of explanation of benefits and payments output. The team configured GUI payment CARC and RAC codes and established rule definitions that governed automated payment decisions and exception routing within the Payment Integrity workflow.
Integrations and data flows included rule handoffs and validation with Verisk, Axiom TransSend, and Emdeon, and data crossover validation from managed care organization feeds to Health Rules. Operational procedures incorporated SQL data pulls, ongoing quality assurance of 028 files for payment runs, and UAT driven validation of outputs to ensure alignment between payer feeds and the configured rules engine.
Governance and rollout mechanisms were led through collaboration with the PMO and AVP, with the Claims Operations Manager serving as UAT group lead. Process controls included documented policies and procedures, a departmental SharePoint repository for project artifacts, Jira ticketing for issue tracking, interdepartmental requirements workshops to create company modules, and a structured UAT and training deployment regimen to operationalize Optum CES within the claims organization.
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