• FIXED
  • PENDING
  • CLEAN
  • ERROR

How to resolve denied claims with your AI

Connect Optum Claims & Billing to your AI client once. Your agent then handles the heavy lifting of finding and fixing coding errors.

Ask AI about this page

Short answer

How can I resolve denied claims using my AI?

Your agent identifies denied claims by checking their status and triggers automated revisions to fix coding mistakes. You get a list of corrected claims ready for resubmission.

Claim outcomes.

Where every claim lands.

The AI sorts every issue into one of these four categories.

FIXED

Ready for resubmission

The AI identified a coding error and applied a revision. These claims are ready to go back out.

PENDING

Needs human review

The AI found an issue it can't fix alone. You'll need to step in and look at these manually.

CLEAN

Already processed

These claims were already successful. The AI flags them so you don't waste time on them.

ERROR

Critical data gaps

The AI found a denial that requires more than just a code change. These stay in your queue for investigation.

The workflow

What your AI does when a denial hits.

The AI takes over the repetitive parts of the denial management cycle.

  1. Identify denials

    Your agent scans your recent activity to find any claims that didn't clear.

    opt_check_claim_status

  2. Analyze error codes

    The AI looks at the specific reason for the denial to see if it's a simple coding mistake.

    opt_check_claim_status

  3. Apply corrections

    Once a fix is identified, the AI updates the claim data to match the required standards.

    opt_handle_denial_revision

  4. Flag complex cases

    If the error isn't a simple code fix, the AI stops and leaves the claim for you.

    opt_handle_denial_revision

Try it

Copy these to start.

Use these prompts to kick off the process.

Starting points

Swap out the bracketed text for your actual claim IDs or patient names.

Optum Claims Connector

You're all set. Choose your MCP client and follow the setup instructions.

Connector linkhttps://edge.vinkius.com/vk_preview_e4xPqwMzSwiBQ7KWDfZCZMaVrl034AScFZetyfpc/mcp

Claude Desktop

Follow the steps below to connect in seconds.

  1. 1In Claude Desktop, open Settings → Connectors.
  2. 2Click “Add custom connector” and paste the connector link above as the remote MCP server URL.
  3. 3Click Add and start a new chat — Optum Claims capabilities are ready to use.
Configuration · claude_desktop_config.jsonCopy
{
  "mcpServers": {
    "optum-claims-billing-mcp": {
      "url": "https://edge.vinkius.com/vk_preview_e4xPqwMzSwiBQ7KWDfZCZMaVrl034AScFZetyfpc/mcp"
    }
  }
}
Copy into chat04

  • Check the status of claim ID [12345] and tell me why it was denied.

  • Find all denied claims from last Tuesday and list the error codes.

  • Run a revision on claim [67890] to fix the coding error.

  • Which denied claims can you fix automatically right now?

  • Claude
  • ChatGPT
  • Cursor
  • VS Code
  • Windsurf
  • Claude Code
  • JetBrains
  • Cline

Start here

Connect Optum Claims & Billing once, then ask.

Just click the link to connect. Your login stays encrypted on our side, and you can find the full list of tools on the Connector page.

Connect Optum Claims & Billing to your AI

FAQ

How this task behaves.

  • 01

    Can the AI submit the claim to the payer?

    No. The AI handles the revision of the claim data, but you must handle the final submission through your billing software.

  • 02

    Will the AI change my original records?

    No. The AI generates revisions based on the tools provided; it does not delete or overwrite your primary database entries without your direction.

  • 03

    Does it fix every type of denial?

    No. It only fixes denials that can be resolved through coding revisions. It will flag more complex issues for you to handle.

  • 04

    How does it know which claims to check?

    It uses the status check tool to look at the claims you specifically ask about or those you tell it to scan.

  • 05

    Can I review the changes before they are finalized?

    Yes. You can ask your agent to show you the proposed revision before it applies the fix.

  • More questions about Optum Claims & Billing? The Connector page answers them. See everything the Optum Claims & Billing Connector can do

Connect Optum Claims to Claude, Cursor, ChatGPT & more