Change Healthcare (Optum)

The largest US medical claims clearinghouse, now part of Optum

Our take

Change Healthcare operates the largest healthcare claims clearinghouse and payment network in the US, moving claims, eligibility checks, remittances, and payments between providers and virtually every payer. The current company was formed in 2017 by combining Change Healthcare Holdings with McKesson's technology business, went public in 2019, and was acquired by UnitedHealth Group for roughly $13B in October 2022, where it now sits inside Optum. Buyers include health systems, medical groups, billing companies, pharmacies, and payers who need high-volume payer connectivity.

Its scale is also why the February 2024 ransomware attack was so damaging. The BlackCat/ALPHV attack halted claims and payment processing for months, disrupted cash flow across much of US healthcare, exposed data on about 192.7 million people (the largest healthcare breach on record), and cost UnitedHealth well over $2B including a $22M ransom payment. Clearinghouse services were not fully restored until roughly nine months later, and state and class action litigation was still active into 2026. It remains the biggest network in the market, but most buyers now treat clearinghouse redundancy as a requirement rather than an option.

What it does

Medical, dental, and pharmacy claims clearinghouse
Eligibility and benefits verification at scale
Electronic remittance and payment services
Claims editing and payment accuracy tools
Clinical data exchange and attachments
Patient billing and payment products

Where it's strong

Unmatched payer connectivity: it remains the default clearinghouse route for a huge share of US claims volume.
Breadth across medical, dental, and pharmacy transactions plus payments means one vendor can cover most exchange needs.
Optum ownership gives it deep resources and long-term viability.

What buyers should weigh

The February 2024 ransomware attack took its clearinghouse down for months, exposed data on roughly 192.7 million people, and cost UnitedHealth over $2B; restoration was not complete until late 2024 and litigation continues into 2026.
Many providers now run a second clearinghouse for redundancy after the outage, and buyers should plan for the same.
Being owned by UnitedHealth raises conflict-of-interest questions for providers and competing payers, and post-attack loan clawbacks strained provider trust.

Latest

Litigation over the 2024 breach continued through 2025 into 2026, including a Nebraska attorney general suit that survived a motion to dismiss and class actions over Optum's provider assistance loan terms.