Case Study: Leading Academic Medical Center achieves $13M annualized savings and cleaner claims with Optum360 Claims Manager

Leading Academic Medical Center - Customer Case Study

Leading Academic Medical Center, a multi-state health system handling more than 2 million patient visits and over 4.4 million professional claims annually, faced a technology consolidation effort to standardize revenue cycle operations. Although the organization had contracted for a replacement solution, their long-standing Optum Claims Manager (Optum360) deployment was not part of that end-to-end implementation, creating a risk of losing proven clinical editing and first-pass claim accuracy during the transition.

The medical center elected to keep Optum Claims Manager from Optum360, preserving its rules-based clinical editing, customizable edits and unbilled-item detection. Over a recent six-month period 13 custom edits fired 10,660 times affecting $5.4M in billed charges, and Optum360’s reporting estimated nearly $13M in annualized administrative savings and additional revenue recognition (43:1 ROI), with fewer denials, cleaner claims and improved first-pass acceptance rates.