• READY
  • ACTION
  • REVIEW
  • PENDING

How to resolve claim denials with your AI

Connect Optum Claims & Billing to your agent to automate the loop between finding a denial and fixing the error.

Ask AI about this page

Short answer

How do I fix denied claims using my AI?

Your AI pulls claim statuses to find denials and then uses corrected data to trigger resubmissions. You get a clean list of actionable errors and ready-to-send corrections.

Claim outcomes.

Where every issue lands.

The AI sorts every claim into one of these four buckets based on its status.

READY

Clean claims

Claims that passed without issues. Your AI identifies these so you can ignore them and focus on the problems.

ACTION

Ready for resubmission

Claims where the AI found the coding error and prepared a fix. These are ready for your final review.

REVIEW

Needs human eyes

Claims with complex denials that the AI can't fix alone. You'll find these flagged for manual investigation.

PENDING

Processing status

Claims currently in flight or awaiting a response from the payer. The AI tracks these so you don't have to.

The workflow

What your AI does when a denial arrives.

The AI handles the repetitive data gathering and the initial correction steps.

  1. Identify denials

    The AI scans your recent submissions to find any claims that were rejected or denied.

    opt_check_claim_status

  2. Analyze errors

    It looks at the denial reason codes to pinpoint exactly which part of the claim failed.

    opt_check_claim_status

  3. Fix coding mistakes

    The AI applies the necessary corrections to the claim data to align with payer requirements.

    opt_handle_denial_revision

  4. Trigger resubmission

    Once the error is fixed, the AI sends the corrected claim back into the system.

    opt_handle_denial_revision

Try it

Copy these to start.

Use these prompts to kick off the process.

Starting points

These are opening lines. Swap out the specific claim IDs or patient names with your actual data.

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 99283 and tell me why it was denied.

  • Find all denied claims from yesterday in the Optum system.

  • Fix the coding error for claim 44521 and resubmit it.

  • List all claims that need a manual review due to complex denials.

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

Start here

Connect Optum Claims & Billing once, then ask.

You only need to link your account once. Your credentials stay encrypted, and you can immediately start asking your agent to manage your claims.

Connect Optum Claims & Billing to your AI

FAQ

How this task behaves.

  • 01

    Can the AI submit claims without me seeing them?

    No. The AI prepares the corrections, but you maintain control over the final submission process.

  • 02

    Will the AI change my original patient records?

    No. The AI only generates corrected claim data for resubmission; it does not modify your primary database.

  • 03

    Can it fix denials caused by missing medical records?

    No. The tools only handle coding and data revisions. If a claim needs new clinical documentation, you have to handle that manually.

  • 04

    How does it know which claims are denied?

    It uses the status query tool to pull real-time data directly from the Optum system.

  • 05

    Does it handle all types of insurance payers?

    It handles any payer that is accessible through the Optum Claims & Billing interface.

  • 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