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Medical Record Review

Discover more about our comprehensive Medical Record Review solution that includes retrieval, abstraction, program management and audit support.

Quality measurement and reporting

How are your quality metrics?

Prospective Solutions

How do we drive more value from outcomes-based programs?

AI-Enabled risk adjustment solution

How smart is your retrospective risk adjustment solution?

Retrospective Risk Adjustment Solutions

We offer comprehensive strategies for health plans.

Submission Services

We provide end-to-end management of submissions, direct errors and remediation. Insights promote continual improvement to maximize accuracy.

Audit Services

How much support do you get during an audit?

Risk management and quality performance

We go beyond risk adjustment to drive better outcomes.

Medicaid Risk Adjustment

Optum has the expertise, breadth and scale to help optimize and support your Medicaid risk and quality programs.

Behavioral health solutions for health plans

Building a better future for behavioral health care with capabilities to support health plans, ­ members and providers across the entire health continuum.

Emergent Care Transformation

Emergent Care Transformation

Targeted cost of care management

Better manage high-spend areas like lab testing or emergency department with solutions that integrate analytics, technology and services.

Laboratory Benefit Management

Manage all routine and genetic lab testing spend.

Pharmacy care services for health plans

We help health plans navigate their toughest challenges.

Specialty Pharmacy Management

We take an integrated approach to controlling specialty costs by managing across both benefits and creating a seamless patient experience.

Pharmacy care support

We prioritize patient care through proactive insights that empower informed decisions and control costs — without compromising excellence.

Payment delivery solutions

With our solutions, payers can increase electronic payment adoption, reduce costs and remove administrative headaches, all while increasing provider satisfaction.

CES Facility

Manage commercial and Medicare facility claims editing.

CES Professional

Eliminate needless administrative, financial, time burdens.

CES Application Managed Services

Automate claims edit services for better accuracy.

Health care operations

We offer a full range of technology services, including applications and infrastructure design, development and operations.

Provider Data Solutions

Maintain and improve your provider data.

Provider Data and Network Management

Improve provider data quality; enhance network strategies.

Claims Editing Services

We use data and powerful editing technology to maximize auditing for government, commercial, Medicaid and Medicare claims.

Claims and Billing Solutions

Expansive claims and billing solutions help preempt denials, send cleaner claims, automate workflows, and improve efficiencies and payments.

Data management

Maximize the quality of your data to increase performance.

Health IT solutions

Learn more about our IT solutions.

Program Integrity Services

Our solution enhances and modernizes program integrity to combat fraud, waste and abuse by working to support the federal government.

Claims Data

Meet your potential with more complete data.

Clinical/EHR Data

Change your perspective on care with more useable data.

Integrated Data

Add another dimension to your data-driven strategies.

Optum Performance Analytics

Unify clinical and financial analytics to improve outcomes.


Our expertise in health care spans policy design to program research and beyond.

Shaping the future of care

Meet the leadership team driving Optum Serve Consulting.

Careers at Optum Serve Consulting

Find career opportunities at Optum Serve Consulting.

Optum Serve consulting solutions

Our health policy and consulting expertise can help you make informed policy choices.

Infusion Pharmacy

Specialty Pharmacy

At Optum Specialty Pharmacy we make patient referrals, enrollment processes and online prescriptions easy for providers.

Support for oncology providers

Pharmacy solutions and services

Drive better engagement, adherence and outcomes for your patients.

Electronic Prescribing (eRx) to Optum Home Delivery

Enable accurate and efficient electronic prescribing to send prescriptions directly to the pharmacy.

Optum Home Delivery Pharmacy

Increase medication adherence and satisfaction while providing patients a cost-effective and easy way to receive prescriptions at home.

Utilize real-time benefit check

Get patient-specific prescription costs, lower-cost options and coverage details right at the point of care through your ERM platform.

Technology Solutions

Improve efficiencies with innovative and flexible solutions.

Clinical Programs

Strengthen patient care through a dedicated clinical team.

Analytics Tools

Drive insights with actionable information and knowledge.

Hospice Pharmacy Solutions

Provide care-focused and cost-effective solutions.

Pharmacy Network

Grant access to local pharmacies, home delivery and infusion

Educational Resources

Access a wide range of resources for staff and patients.

Optum Pay

Accelerate progress toward a healthier future with a platform that helps expedite payments and streamlines access to historical claims data.

How to enroll

Streamline your payment experience with Optum Pay.

Payments and lending

Optum Financial® is setting a new standard for how care is financed and paid for.

Patient Care Management

Manage patient care across the health care ecosystem.

Analytics Managed Services

Service-Line Profitability

Increase surgical volume and improve patient care.

Itemized Bill Review

Save on high-dollar inpatient cases.


Maximize recoveries with member sensitivity.

Claims Pricing Solutions

Drive prospective payment system pricing accuracy and efficiency with Optum® EASYGroup™.

Claims Validation

Validate all claims while minimizing provider abrasion.

Network Solutions

Our solutions focus on out-of-network claims.

Comprehensive Payment Integrity

Centralize payment integrity for increased results.

Credit Balance

Maximize overpayment recovery.

Data Mining

Identify and recover payment errors.

Coordination of Benefits

Identify critical administrative coordination of benefits issues.

Maternity Support Programs

Help deliver healthier babies and better outcomes.

Fertility Solutions

Improve fertility outcomes and reduce costs.

Neonatal Support

Help improve outcomes for infants in the NICU, and assist families in caregiving.

Women’s Health Solutions for Health Plans

Support women and families with integrated solutions.

HEDIS Medical Record Review

Streamline HEDIS data collection and medical review process.

Bariatric Resource Services

Offer cost-effective, quality proven, weight-loss surgery.

Managed Transplant Program

Manage the risks of complex medical conditions.

Transplant Solutions

Get significant savings and statistically superior outcomes.

Complex care management for payers

Discover simple solutions for complex conditions.

Kidney Solutions

Attain comprehensive, cost-effective disease management.

Musculoskeletal (MSK) Solutions

Manage escalating spend and utilization.

Oncology Care Management Programs

Manage cancer costs, improve outcomes and quality of care.

Focused Claims Review

Ensure billing accuracy of professional and facility claims.

Specialty Pharma Solutions

Manage specialty medical drug expenses.


Help manage member care and close Star gaps with in-home member assessments.

Stars/HEDIS Strategy and Operations

Strengthen quality initiatives to boost Stars ratings and improve performance.

Transform Specialty Medication Management

Eliminate the burden of managing specialty medications separately across the medical and pharmacy benefit.

Member health and care management

We strive to shape a health system that works best for the member's whole health and provide care as needed.

Rally Rewards

Rewarding members for repeat engagement in healthy actions.


Overcome barriers to engage employees in their health.

Health and Wellness Portal Solutions

Reduce health risks and help prevent chronic disease.

Disease and Condition Management Programs

Identify at-risk individuals and help resolve health care gaps.

Care Management Solutions

Drive value with improved health outcomes and reduced costs.

Asthma Management Programs

Help people make positive changes to improve their health.

Care Coordination for Chronic Conditions

Provide support and advice a member needs to restore their health.

Biometric Screening Solutions

Offer biometric screening options for your whole population.

PCPs and the Optum ISNP Care Model in SNFs

Close gaps in care and reduce fragmentation by participating in a cross-functional, team-based care experience.

The Optum Care Model

Improve quality and maintain census stability by bridging care for senior living residents.

The Optum ISNP Care Model for SNFs

Break the high-cost cycle by increasing care and benefits to Institutional Special Needs Plan (ISNP) members.

Behavioral health services for state government

Helps improve outcomes for high-risk populations.

Integrated Solutions for I/DD Populations

Ensure predictable costs while supporting positive outcomes.

Behavioral Programs for the Justice-Involved

Optum helps direct people with behavioral health disorders in the criminal justice system to appropriate clinical and support services.

Peer Support Services for Behavioral Health

Our peer services help people move from treatment to daily life and reduces re-admission.

Optum Integrated Eligibility Services

Simplify eligibility and enrollment for your HHS programs.

Optum State Insurance Exchanges

Simplify access to care with a state-based exchange that meets all your marketplace needs.

Health care access

Simplify access to care for your health and human services (HHS) programs.

Optum COVID-19 Vaccine Billing Services

Quit Services

Learn how Optum is providing fresh insights for states to modernize tobacco cessation programs.

Public health solutions

Transform public health in your state.

Optum Center for Wellbeing Research

A Trusted Partner in a Time of Crisis

We're taking action to support state governments. Find the resources you need to predict, respond and recover from the pandemic.

Data and analytics

Improve decision-making and outcomes with a suite of advanced enterprise analytics products.

Policy Research, Analytics and Consulting

Understand program results to deliver more value.

Program Integrity

Protect taxpayer money by decreasing improper payments.

Automated Health Care Claims Triggers & Notifications

We help state agencies maximize auditing capabilities.

CES Facility

Manage commercial and Medicare facility claims editing.

Advanced Communication Engine

Prevent claim inefficiency and lower administrative costs.

CES Professional

Eliminate needless administrative, financial, time burdens.

CES Application Managed Services

Automate claims edit services for better accuracy.

Provider Management Services

Streamline, manage and improve your Medicaid providers’ experience.

Optum Claims Administration

Modernize your claims administration process.

Optum Maintenance and Operations Services

Help reduce costs and system instability by outsourcing M&O.

Program operations

Transform your operations with modern technology complemented by services.

Optum Interoperability and Patient Access Services

Optum Utilization Management

Deliver appropriate care quickly and efficiently.

Specialty Pharmacy Management for state government

We take an integrated approach to controlling specialty costs by managing across both benefits and creating a seamless patient experience.

Pharmacy care services for public sector

We help you provide affordable pharmacy benefits.

Claims and payment accuracy

Optum® Payment Integrity strengthens accuracy at every touch point in the billing lifecycle.

Emergency Department Claim Analyzer

Control rising emergency outpatient facility cost.

Claims Edit System

Edit claims for all business lines and claim types.


The Optum® Symmetry® suite produces standard units of analysis to help health plans manage costs, mitigate risk and measure quality.

Analytics Consulting

Analytics Consulting

Data and analytics enablement

Better understand and predict cost, risk and quality.

Impact Pro

Optum® Impact Pro® helps you identify individuals who will benefit most from population health management programs.

Patient Help Line

Optum experts address patients’ immediate symptom concerns and clinical questions, day or night, 365 days a year.

Chronic Care Management for Medicare

It's more than revenue — it's value.

Physician Practice Performance

Solve challenges in ambulatory operations related to population health management (PHM), value-based care (VBC), patient engagement and revenue cycle.

IT Performance

We enable partners with the technology, expertise, secure operations and economics to digitally transform health care for improved outcomes.

Revenue Cycle

Innovate the revenue cycle for peak performance.

Market Advantage

Develop your future growth strategy. Our planning solution provides analytics, business development guidance and implementation support.

Engage Physicians in Care Transformation

Analytics Performance

Health care can do better — and no one can do it alone.

Network Planning

Develop, refine and enhance network planning.

Precision Marketing - Health Care Providers

Learn how our precision marketing services can help you more effectively reach and engage patients who need your services and increase your marketing ROI.

Performance Analytics

Military and Veteran health services

We provide high-quality and reliable health services.

Global corporate health solutions

How do you engage employees around the world?

Digital Engagement

Motivate more employees to take charge of their health.

Global emotional wellbeing solutions

Improve well-being and productivity.

Creating a Safe Return-to-Worksite Strategy

What types of COVID-19 resources suit your worksite needs?

Support a Return to Routine Care

Find accessible care to reduce risks and close critical gaps in care.

COVID-19 Vaccine Support

Discover what employers need to know about COVID-19 vaccines.

Address Mental Health Challenges from COVID-19

Attend to the explosion of need due to COVID-19.

Pharmacy care services for TPAs

We provide dedicated support to help you grow your business.

Specialty Medication Management for Employers

We take an integrated approach to controlling specialty costs by managing across both benefits and creating a seamless patient experience.

Pharmacy benefit management (PBM)

As a pharmacy benefit manager, our goal is to improve the cost of health care and prescription drugs for both plan sponsors and members.

Stop Loss Insurance

Protect your self-funded employer benefit plan from excessive expenses related to increased health care utilization.

Health Reimbursement Arrangements

Use a health reimbursement arrangement (HRA) to help offset employees’ health care costs while providing tax savings to the organization.

Health Savings Accounts

Accelerate progress toward a healthier future with an HSA that helps employees take control of their care, payments and overall health.

Financial solutions

Empower your employees to take control of their health and lead them toward greater financial wellness.

Commuter Benefits

Support your employees with a pre-tax account that saves them money on qualified expenses for their individual commute to work.

Flexible Spending Accounts

Help your employees budget and save for qualified expenses during the benefit plan year through pre-tax contributions to FSAs.

Healthy food benefits

Make fresh produce and healthier food a realistic option for all of your employees with instant rewards for purchasing nutritious products.

Lifestyle Spending Accounts

Attract and retain talent in a competitive market, connect your benefits to your culture and show you care for your employees.

Prevention and well-being

Help employees be healthier.

Rally Rewards

Rewarding members for repeat engagement in healthy actions.


Overcome barriers to engage employees in their health.

Consumer Engagement Portal

Help employees make sustainable changes to reduce risks.

Biometric screenings and vaccinations

Engage employees with biometric screenings and vaccinations.

Risk Management

Reduce worries with sustained financial risk management.

COPD Management

Provide personalized support for managing COPD.

Coronary Artery Disease Management

Improve health and lower costs for those living with the most common form of heart disease: CAD.

Condition Management

Provide the right resources at the right time to meet needs.

Diabetes Management

Help your employees living with diabetes by providing one-to-one support.

Asthma Management

Help your employees living with asthma make positive changes to improve their health.

Heart Failure Management

Our dedicated nurses help empower healthier choices to manage heart failure.

Maternity Support Program

Help deliver healthier babies and better outcomes.

Neonatal and NICU Support Programs

We help improve clinical outcomes for infants admitted to the NICU, and assist families in preparing for their new caregiver roles.

Population health services

Complex Medical Management

Our specialty network offers focused clinical interventions.

Benefits Analytic Manager

Manage benefit performance with valued insights.

Women's Health Solutions for Employers

We offer help from preconception through baby's first year.

Solutions for Health Care Providers

Increase employee engagement and control medical plan costs.

Clinical Case Management

Empower your employees with chronic or complex conditions.

Peggy O’Reilly, RN

Case Manager, Women’s Health Solutions, Optum

Fertility Benefit Programs

Reduce infertility treatment costs, decrease NICU costs.

Shelly Roy

Social Worker, Optum Women’s Health Solutions

NurseLine Services

We provide 24/7 support to help people understand their symptoms.

Optum Guide

Simplify benefits to guide and empower employees.

Oncology Care Management Programs

Ensure the right care at the right time with the right provider.

Bariatric Services

Offer cost-effective, quality-proven, weight-loss surgery.

Complex care management for employers

Discover simple solutions for complex conditions.

Managed Transplant Program

Manage the risks of complex medical conditions.

Kidney Solutions

Attain comprehensive, cost-effective disease management.

Musculoskeletal (MSK) Condition Services

Manage escalating spend and utilization.

Focused Claims Review

Ensure billing accuracy of professional and facility claims.

Substance Use Disorders

We offer resources and support to help individuals achieve stabilization, build resiliency and sustain recovery.

Return Better

Find comprehensive solutions for employers and employees throughout the COVID-19 pandemic and beyond.

Oncology and Immunology Research

Cardiovascular Disease Research

We develop research to advance treatment of CVD.

Voice-to-Claim Research

The Optum® HEOR Primary Data Collection (PDC) team focuses on real-world evidence generation through primary and secondary data.

Central Nervous System and Behavioral Health Research

We offer insightful, real-world research in CNS and BH.

Diabetes and other endocrine diseases research

Strengthen your value story with HEOR

Tap into our expertise in health economics and outcomes research.

Respiratory disease research

Infectious Disease Research


Engage payers with value-based contracts

Assess the fit, develop metrics and track care outcomes over time.

Digital Research Network for Providers

Data and technology combine to help providers enroll patients in clinical trials for better outcomes.

Enhance Clinical Trial Design and Performance

Modernize your approach to protocol design and patient finding.

Design, Pilot and Scale Engagement Programs

Take advantage of our connections to all parts of the health system.

Generate Evidence with Real-World Data

Derive evidence from the unmatched depth and scale of our data assets.

Health Care Claims Data and Analysis

Integrating and linking deep patient data from multiple real-world sources helps clarify market dynamics.

Market Clarity: Linked EHR and Claims Data

Unlock insights using the industry’s largest and most trusted repository of longitudinal clinical and claims data.

EHR Data

Gain visibility across therapeutic areas and the continuum of care.

Dynamic Assessment of Pregnancies & Infants (DAPI)

Drive informed decisions about maternal and infant health.

Partner with Our Epidemiology Consultants

Advance public health and safety with our trusted experts and data.


Better understand diseases and drug development opportunities.

Clinformatics for Managed Markets

Achieve greater marketplace power.

Empower Commercial, Brand and Access Teams

Reveal market opportunities using our data assets and expertise.

Specialty and Infusion Support for Hospitals

Medication therapy management

The Medication Therapy Management Program (MTMP) improves outcomes for Medicare Part D/Optum Rx members who meet specific medical criteria.

Optimize your pharmacy network strategy

Our full-spectrum pharmacy services are designed to provide affordable access to prescription medications and therapies.