Optum Solutions for the Public Sector

• SGS AI Capabilities: A reusable, responsible AI capability foundation embedded across Optum State Government solutions that helps teams understand documents, support members, providers and staff, identify risk, review evidence and accelerate service delivery. Capabilities include document intelligence, language access, voice-enabled assessments, call intelligence, provider enrollment and prior authorization support, agentic analytics and investigation, audit support, forms automation and AI-assisted modernization. All are designed to support human decision-making with transparency and operational control.

Turn data into action with enterprise analytics, program integrity, reporting and consulting.

• Optum Program Integrity: A comprehensive, AI-enabled program integrity solution that supports state Medicaid agencies across the claims lifecycle, spanning pre-adjudication, pre-pay and post-pay capabilities. It helps states prevent improper payments, identify high-risk claims prior to payment and detect potential fraud, waste and abuse post-payment. Agentic investigation capabilities help teams prioritize leads and review evidence, with decisions staying with investigators. Deployment is flexible and aligned to state priorities and operational maturity.
  • Video: https://business.optum.com/content/dam/optum-dam/resources/videos/business/pre-pay-demo/pre-pay-self-running-demo.mp4
• Optum Health Care Performance Analytics: A comprehensive analytics solution, part of Optum Performance Analytics for HHS, that helps agencies improve program performance, support financial stewardship and strengthen population health. It does this through intuitive reporting, connected insights, predictive models and agentic AI capabilities that help analysts research questions and surface findings.
  • Sell sheet: Attached
• Rural Health Transformation Solutions: Optum helps states plan, carry out and report on their Rural Health Transformation (RHT) Program initiatives through consulting, strategic program management, advanced analytics and enabling technology. We bring fragmented claims, clinical, workforce and social needs data into one trusted foundation that informs investment priorities and performance measures. Monitoring dashboards then help states track progress and meet CMS reporting requirements across priorities like telehealth, digital health and infrastructure, value-based care, maternal and behavioral health, and workforce development.
  • Sell sheet: Attached
• Optum Rapid Insights as a Service: A rapid-deployment analytics offering for Medicaid agencies that delivers out-of-the-box insights, including population risk, chronic conditions and social drivers, in as little as one month. Optum consulting support helps agencies turn those insights into action and accelerate data-informed decision-making.
  • Sell Sheet: Attached
• Optum State and Federal Reporting: A CMS-aligned reporting solution that helps states produce required federal reports and T-MSIS extracts, improve data quality and strengthen transparency through robust validation, documentation and drill-down reporting.
  • Video: https://www.optum.com/content/dam/o4-dam/resources/videos/state-govt-demo/optum-data-quality-ews-self-running-demo.mp4
• Optum State Data Hub: A scalable, cloud-enabled data platform designed for state government that supports secure data integration, interoperability, governance and advanced analytics across programs and systems.

Streamline provider management, contact centers, LTSS and assessments with intelligent automation.

• Optum One Assist: A secure, scalable, omnichannel engagement platform that supports Medicaid and human services programs by improving contact center operations, enhancing service quality and delivering more seamless experiences for members, providers and stakeholders.
  • Video: optum.com/content/dam/optum-dam/resources/videos/business/one-assist/one-assist-chapter-1.mp4
• Optum Provider Management Services: A configurable provider lifecycle management solution that supports enrollment, credentialing, revalidation and ongoing maintenance. AI-assisted features, including an Enrollment Assistant, document prefill and an Enrollment Advisor that recommends fixes before submission, help improve the provider experience while strengthening program compliance and oversight. Proven in Montana and CMS-certified.
  • Sell Sheet: Attached
• Independent Assessment: A standardized, technology-enabled assessment solution that combines policy-aligned tools, trained assessors and integrated workflows to support scheduling, reporting, appeals tracking and consistent, equitable service determinations.
  • Sell Sheet: Attached
• Optum LTSS: A technology-enabled solution for long-term services and supports that brings together assessment, service authorization, program integrity, provider engagement, reporting and contact center capabilities to support coordinated, person-centered care and program oversight.

Simplify eligibility and enrollment with integrated, AI-enabled capabilities.

• State-Based Exchange / Integrated Eligibility / M&O Services: Optum helps states modernize eligibility with a structured approach that keeps systems stable while improving performance over time. Our modernization and operations capabilities support eligibility and enrollment across Medicaid and human services programs, enable no-wrong-door access and provide end-to-end system implementation, operations and ongoing optimization.
  • AlwaysOn and AutoVerify: AlwaysOn resolves routine Medicaid renewal discrepancies before they become manual cases. It starts with existing data, asks members only for what's missing and hands workers a complete case that's ready to review. AutoVerify turns submitted documents into structured evidence. States keep control of the rules, thresholds and every official decision. Their eligibility system stays in place, and workers can focus on the cases that need their judgment.
    • Video: https://www.optum.com/content/dam/internal-resources/videos/eligibility-demo/eligibility-demo.mp4
• Optum Community Engagement Verification Solution: A solution that helps states meet community engagement requirements by combining verification services, secure integrations and optional AI-enabled automation for document processing and anomaly detection, without requiring changes to core eligibility systems.