UnitedHealth automates claims

UnitedHealth’s Optum unit is rolling out artificial intelligence agents to handle about 40% of routine medical claims and prior authorization work. (markets.financialcontent.com) The company profile published April 15 said the tools are aimed at routine processing, not the hardest coverage disputes, and are being pitched as a way to move claims faster and cut administrative friction for doctors. (markets.financialcontent.com) Optum had already started pushing this direction in October 2025, when it introduced an artificial-intelligence claims platform called Optum Real that gives providers real-time coverage and reimbursement information. Allina Health was named as an early pilot for outpatient radiology and cardiology. (optum.com, healthcarefinancenews.com) Claims processing is the back-office work that checks whether a service is covered, whether the billing code matches the visit, and how much the insurer will pay. Prior authorization is the separate step where a doctor must get approval before some treatments, scans, or drugs are covered. (optum.com) UnitedHealth is making this push after the February 2024 ransomware attack on Change Healthcare, the claims and payments network it bought in 2022. The outage disrupted billing and payment flows across the United States and drew congressional scrutiny, federal investigations, and lawsuits from state officials. (congress.gov, hhs.gov, healthcareinfosecurity.com) In his May 1, 2024 testimony to Congress, then-chief executive Andrew Witty said Change Healthcare handled roughly 15 billion health care transactions a year and touched about one in every three patient records in the country. That scale is why any effort to automate even “routine” claims work lands far beyond one insurer’s back office. (congress.gov) Federal regulators treated the cyberattack as unusually large. The Department of Health and Human Services said its Office for Civil Rights opened investigations into both Change Healthcare and UnitedHealth Group over possible protected health information breaches and compliance with federal privacy and security rules. (hhs.gov) The company is also trying to reset relations with providers after the attack’s financial fallout. In April 2025, CNBC reported that UnitedHealth was pressing doctors to repay no-interest loans the company had issued during the outage to keep practices afloat. (cnbc.com) UnitedHealth has framed 2026 as a rebuilding year. In its January 2026 outlook, chief executive Stephen Hemsley said the company finished 2025 “as a much stronger company,” after booking $799 million in final cyberattack costs for the year. (unitedhealthgroup.com) The test for this rollout is not whether claims move from humans to software on paper. It is whether doctors see fewer delays, fewer resubmissions, and fewer payment disruptions than they did when UnitedHealth’s systems failed in 2024. (markets.financialcontent.com, congress.gov)