List of Optum Payment Integrity Customers
Eden Prairie, 55344, MN,
United States
Since 2010, our global team of researchers has been studying Optum Payment Integrity 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 Payment Integrity 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 Payment Integrity for Payment Integrity include: Kaiser Foundation Health Plan, a United States based Healthcare organisation with 223883 employees and revenues of $100.80 billion, Blue Shield of California, a United States based Insurance organisation with 7800 employees and revenues of $27.44 billion, L.A. Care Health Plan, a United States based Insurance organisation with 2500 employees and revenues of $9.00 billion, CountyCare Health Plan, a United States based Insurance organisation with 6272 employees and revenues of $2.84 billion, Blue Cross & Blue Shield of Rhode Island, a United States based Insurance organisation with 1100 employees and revenues of $2.05 billion and many others.
Contact us if you need a completed and verified list of companies using Optum Payment Integrity, 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 Payment Integrity 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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Aetna Better Health of Kansas | Insurance | 1500 | $200M | United States | Optum | Optum Payment Integrity | Payment Integrity | 2024 | n/a |
In 2024 Aetna Better Health of Kansas implemented Optum Payment Integrity to centralize Payment Integrity activities for its Medicaid plan in Kansas. The deployment was positioned to strengthen claims payment oversight while operating alongside established vendor engagements with Cotiviti and Equian that perform targeted prepayment and post payment claim reviews.
Optum Payment Integrity was configured to support data mining driven post payment validation, rules-based prepayment screening, and workflow orchestration for referral of cases to external reviewers. Functional capabilities emphasized in the implementation include claims accuracy validation against clinical and payment policies, coding validation workflows for DRG Complex Chart Validation CCV, coordination of benefits retrospective review workflows, and automated provider notification generation when overpayments or coding changes are identified.
Operational execution was coordinated with Cotiviti and Equian where Cotiviti conducts datamining, DRG CCV reviews, COB retrospective reviews, and provider medical record requests, while Equian conducts facility claim coding reviews and post payment identification of overpayments. The rollout touched claims operations, provider relations, clinical review teams, and compliance functions, with the application orchestrating case assignment, documentation requests, and provider outreach tracking in support of those third party review activities.
Governance workflows implemented aligned reviewer outputs and provider notifications to Aetna clinical and payment policies, national coding standards such as ICD 10 and CMS guidance, and provider contract terms. Notification and recovery processes were formalized, with letters to providers documenting overpayments, claim and member details, and coding revisions when DRG assignments changed, reflecting a controls focused approach to Payment Integrity operations.
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Ambetter Health | Insurance | 300 | $100M | United States | Optum | Optum Payment Integrity | Payment Integrity | 2022 | n/a |
In 2022, Ambetter Health implemented Optum Payment Integrity in a Payment Integrity deployment to strengthen claims review and payment controls. The initial implementation established Optum Payment Integrity as the core application for programmatic claim scrutiny, with emphasis on rule-based prepayment reviews and claims analytics capabilities.
The deployment was configured to execute automated prepayment claim reviews and identify overutilization of services, leveraging Optum’s Comprehensive Payment Integrity CPI tool to surface billing patterns inconsistent with widely acknowledged national billing guidelines. Functional capabilities implemented included claims rules orchestration, exception routing for clinical review, and standardized billing validation to support uniform billing practices across provider submissions.
Operational scope included a targeted rollout of additional prepayment claim reviews for Ambetter from WellCare of New Jersey, with provider notifications indicating that these reviews would begin on May 1, 2023 using Optum’s CPI tool. Governance and process changes aligned payment integrity policy to national guidelines, prioritizing prevention of overpayments due to waste or abuse and instituting formalized prepayment review workflows and provider communication protocols.
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Blue Cross & Blue Shield of Rhode Island | Insurance | 1100 | $2.1B | United States | Optum | Optum Payment Integrity | Payment Integrity | 2018 | n/a |
In 2018, Blue Cross & Blue Shield of Rhode Island implemented Optum Payment Integrity. The insurer continues to operationalize Optum Payment Integrity across its claims processing and payment integrity operations, and effective July 2024 BCBSRI will begin performing additional prepayment claim reviews using Optum’s Comprehensive Payment Integrity CPI tool to ensure that claims process and pay accurately. As part of the July 2024 change providers may be asked to submit medical records and billing documents that support billed charges, and after medical records are reviewed the claim is processed to pay when documentation supports the claim as billed. The initiative is explicitly framed to prevent overpayments due to waste or abuse and to strengthen prepayment review controls.
The Optum Payment Integrity implementation leverages capabilities typical to the Payment Integrity category, including rules based prepayment review, clinical documentation review workflows, claims adjudication orchestration, and provider inquiry handling. Configuration emphasizes prepayment claim hold and documentation request orchestration, clinical review touchpoints, and integration points into the existing claims adjudication pipeline to allow documentation driven adjudication outcomes. Governance covers provider communication protocols for medical record requests, documentation based adjudication rules, and standard operational workflows for review and release of paid claims, with explicit operational scope in claims and payment integrity functions. This deployment positions Optum Payment Integrity as the operational toolset for BCBSRI’s ongoing efforts to identify and prevent improper payments through prepayment review and clinical documentation validation.
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Insurance | 7000 | $1.4B | United States | Optum | Optum Payment Integrity | Payment Integrity | 2018 | n/a |
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Insurance | 7800 | $27.4B | United States | Optum | Optum Payment Integrity | Payment Integrity | 2017 | n/a |
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Insurance | 900 | $2.0B | United States | Optum | Optum Payment Integrity | Payment Integrity | 2023 | n/a |
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Insurance | 570 | $1.4B | United States | Optum | Optum Payment Integrity | Payment Integrity | 2022 | n/a |
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Insurance | 6272 | $2.8B | United States | Optum | Optum Payment Integrity | Payment Integrity | 2022 | n/a |
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Insurance | 500 | $100M | United States | Optum | Optum Payment Integrity | Payment Integrity | 2014 | n/a |
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Insurance | 7300 | $430M | United States | Optum | Optum Payment Integrity | Payment Integrity | 2019 | n/a |
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Buyer Intent: Companies Evaluating Optum Payment Integrity
- Avenir Digital, a United Kingdom based Professional Services organization with 5 Employees
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