First Application in Next-Generation Suite Offers Higher Auto
Adjudication Rates, Improved Quality and Transparency, and
Superior Scalability and Flexibility
Redwood Shores, Calif. - Jan. 18, 2012
News Facts
, a highly configurable, rules-driven claims system that
helps payers reduce administrative costs and increase member
and provider satisfaction. The application enables healthcare
payers to:
Easily configure business rules to process more complex claim
scenarios automatically, increasing consistency in claims
payments while reducing the number of claims processed
manually;
Achieve more accurate first-pass adjudication of claims,
reducing the number of claims requiring manual review and
thus lowering administrative costs;
Create business rules to precisely reflect the benefits
offered, avoiding manual errors that can lead to over- or
under-payment of claims;
Accelerate payments to providers and members, improving
service levels;
Avoid payment adjustments by automatically detecting and
flagging potential errors across all claim types.
Using a user-friendly approach to business rules creation,
payers can quickly - and without the need for custom software
code - change the software's settings to meet new regulatory
requirements and support new products or benefits.
With Oracle Insurance Claims Adjudication for Health,
insurers can create rules governing any type or set of codes
- including procedure, diagnosis, provider, facility and
custom codes. The solution is International Classification of
Diseases, 10th Edition (ICD-10) compliant, preparing U.S.
health insurers for the 2013 phase-in date.
The solution supports major medical, dental, vision and
behavioral health claims. The application is designed to
scale for very high volumes to support consolidation of
various claims engines into a single instance.
Oracle Insurance Claims Adjudication for Health integrates
easily with financial systems - such as - for end-to-end
claims processing and payment. Additional out-of-the-box
integration points support the exchange of data with customer
relationship management (CRM), membership accounting,
provider management and other critical payer systems, as well
as with third-party systems.
, Oracle Insurance Claims Adjudication for Health is the
first application in a planned, next-generation suite of core
solutions for health insurance companies. The component-based
architecture of these applications allows healthcare payers
to avoid a risky "big bang" replacement of their current
systems, making the most out of their existing IT
investments.
The claims application was recently implemented at , the
number one private health plan in America for eight straight
years, according to the National Committee for Quality
Assurance.
Supporting Quotes
"In a highly tumultuous market, healthcare payers who can
reduce their administrative costs by even a percentage point
can achieve a huge competitive advantage. In addition, payers
are seeking to position themselves for future market
requirements such as healthcare reform. A high performing,
flexible, auto-adjudicating claims system can serve as the
foundation for transaction efficiency, and as a timely and
reliable data source that will drive future market
opportunities and better health and clinical
decision-making," said Janice Young, program director, payer
IT strategies, IDC Health Insights.
"Health insurers are targeting their claims operations with
the goal of reducing costs and increasing agility related to
benefits, networks and re-imbursement models. However, they
are often constrained by inflexible legacy systems that are
expensive to adapt. Oracle Insurance Claims Adjudication for
Health offers a flexible, highly scalable component approach
which enables a phased implementation path. The rules-based
solution offers a higher level of automated claims
adjudications, improves quality and transparency, and
provides the flexibility that insurers need to outpace the
competition," said Michiel Walsteijn, vice president, Oracle
Health Insurance Solutions.
Supporting Resources
About Oracle
Oracle engineers hardware and software to work together in
the cloud and in your data center. For more information about
Oracle (NASDAQ:ORCL), visit www.oracle.com.
About Oracle in Industries
Oracle industry solutions leverage the company's
best-in-class portfolio of products to address complex
business processes relevant to insurance, helping speed time
to market, reduce costs, and gain a competitive edge.
Trademark
Oracle and Java are registered trademarks of Oracle and/or
its affiliates. Other names may be trademarks of their
respective owners.
Contact Info
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