Case Study: UCare achieves 30% cost savings and improved provider satisfaction with Optum's EDI pre-adjudication solution

UCare improves provider satisfaction and reduces costs through administrative simplification

UCare, the fourth-largest health plan in Minnesota serving over 230,000 members, faced inefficiencies from managing nearly 20 separate EDI vendor connections and needed a single pre-adjudication platform to prepare for HIPAA 5010 regulatory changes. After evaluating vendors, UCare selected RelayHealth and its Payer Connectivity Services Premier (PCS) with Submitter Management Services to simplify submitter management, enforce business rules, and reduce manual claim review.

RelayHealth implemented PCS as a hosted, SaaS pre-adjudication gateway, consolidating more than 20 connections to a single transmission point in a 90-day conversion. The solution reduced administrative work and manual reviews, improved provider self-service and auto-adjudication, enabled on-schedule 5010 compliance, and produced estimated savings of 25–30% per claim and over 30% in administrative cost reductions for UCare.

UCare

Rose Marie Tetzlaf

Director of Claims Operations