Case Study: Leading Small Managed-Care Health Plan achieves CAQH CORE certification, avoids $1.5M/year penalties, and launches Medicaid coordinated-care benefit with Optum

Leading Small Managed-Care Health Plan - Customer Case Study

Optum was engaged by the Leading Small Managed-Care Health Plan to provide IT project management and consulting services to achieve CAQH CORE Phase I–III certification and modernize its ITMS, provider data management, and Medicaid benefit rollout. The plan faced a complex, multi-departmental compliance effort with a tight nine‑month deadline and risk of substantial state fines if certification was not achieved.

Optum assigned a PMP-certified consultant who led cross-functional teams to implement new electronic data interchange transactions, coordinate CAQH testing, select and roll out Remedyforce, and build a provider network system feeding a real-time web portal. Optum delivered all major projects on time and under budget—avoiding approximately $1.5 million per year in penalties—launched a new coordinated Medicaid benefit, completed more than ten projects, and maintained on-site leadership for over four years.