How Optum’s Claims Editing System Got So Big the DOJ Forced a Divestiture That Became Lyric, Why Its PPS Pricer Touches Medicare Advantage Facility Claims, and Why Data Plus Distribution Matters

The DOJ tried to block a $13B healthcare deal because two companies together would have controlled ~95% of first-pass claims editing. Most people have never heard of that market. Here is why it matters.

Optum had ~25% of claims editing. Change Healthcare’s ClaimsXten had ~70%. Combined HHI was in the high 8,000s. The fix: UnitedHealth carved out ClaimsXt…