Change Healthcare

What it does

Change Healthcare (now part of Optum following UnitedHealth Group acquisition) is one of the largest healthcare technology companies in the US - operating a clearinghouse that processes approximately 15 billion healthcare transactions annually including medical claims, eligibility verification, remittance advice, and clinical data exchange. AI capabilities include AI-powered claims editing that catches billing errors before submission, intelligent denial prediction flagging claims likely to be denied, automated prior authorization for routine requests, and clinical decision support surfacing relevant data at the point of care. Change Healthcare's clearinghouse position gives its AI models unparalleled data on payer behavior and claim outcomes.

Strengths

• Hospital systems and physician groups use Change Healthcare for claims clearinghouse services - AI claims scrubbing reducing denials and automated eligibility verification streamlining patient access workflows.
• Large health systems and payers use Change Healthcare for enterprise healthcare data exchange - AI revenue cycle optimization across millions of claims monthly and clinical data integration across the ecosystem.
• Change Healthcare (now part of Optum following UnitedHealth Group acquisition) is one of the largest healthcare technology companies in the US - operating a clearinghouse that processes approximately 15 billion healthcare transactions annually including medical claims, eligibility verification, remittance advice, and clinical data exchange.

Watch-outs

• 2024 cyberattack created significant disruption: Change Healthcare suffered a major ransomware attack in February 2024 that disrupted claims processing for weeks — organizations should evaluate business continuity plans and clearinghouse diversification.
• Optum acquisition raises conflict of interest concerns: Ownership by UnitedHealth Group's Optum subsidiary has raised regulatory concerns about data access and competitive fairness that some health systems are evaluating.
• Concentration risk: Change Healthcare processes such a large share of US healthcare transactions that its disruption demonstrated concentration risk — health systems should understand clearinghouse diversification options.

Pricing

Clearinghouse pricing based on transaction volume. Not published. Enterprise contracts negotiated. Typically per-claim fees or bundled transaction pricing.