Financial Services and Insurance Edition
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New Claims Adjudication Solution Reduces Costs for Healthcare Payers

Oracle introduced a new solution for automating claims adjudication for healthcare payers that enables straight-through processing for nearly all claims, leading to lower administrative overhead and greater claims accuracy. This improved accuracy can in turn reduce overall claims payments and increase both member and provider satisfaction.

Oracle Insurance Claims Adjudication for Health can evaluate nearly all claims using prewritten business rules. The solution allows business users to quickly author and revise rules—in user-friendly language—to tailor claims processing to their specific needs, keep pace with policy or regulatory changes, and support a new product or benefit.

The solution also helps healthcare organizations calculate and track deductibles and other member cost-sharing, benefit limits, and authorizations. When exceptions arise, Oracle Insurance Claims Adjudication for Health can send them to workflow systems to accelerate manual reviews.

Benefits include
  • Lower administrative costs
  • Faster processing times
  • Increased autoadjudication rates
  • Higher claims accuracy rates
  • Increased member and provider satisfaction
Early Adopter
Harvard Pilgrim Health Care is using the claims adjudication system to improve claims accuracy and reduce operating expenses.

“With this project, we expect to achieve three goals," says Eric Schultz, president and chief executive officer. "One is to respond to the needs of the marketplace by keeping healthcare as affordable as possible. Secondly, we want to reduce expenses—healthcare insurance is a highly competitive business, and our ability to reduce our operating costs by even a point or two is a huge competitive advantage. And finally, we want to process millions of transactions every year consistently and accurately, so we can continue to provide the best service possible to our members and support our innovative product and provider strategy."

Get more details about Oracle Insurance Claims Adjudication for Health, read about how Harvard Pilgrim Health Care is benefiting from its implementation, and watch a new Webcast about the solution.

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