Oracle Insurance Claims Adjudication for Health provides automated claims adjudication for the full spectrum of healthcare claims. The application provides comprehensive, out-of-the-box support for a wide range of healthcare claims processes while being flexible enough to allow any healthcare payer to tailor the solution to its specific needs.

• Evaluates claims in real time based on user-configured rules
• Sends exceptions to workflow to accelerate manual review
• Delivers comprehensive support for a wide range of claim types
• Supports both standard coding terminologies such as ICD-10 as well as custom coding schemes
• Provides comprehensive visibility of member and family level benefits utilization and provider utilization
• Offers numerous out-of-the-box integration points
• Provides highly scalable architecture to support changing organizational needs

• Helps healthcare payers achieve high rates of auto-adjudication and processing accuracy while realizing significant operational savings
• Helps ensure that claims are processed and paid more quickly and accurately the first time, improving member, employer, and provider satisfaction
• Enables payers to quickly introduce new products, reimbursement models, and benefit interpretations to keep pace with evolving marketplace conditions
• Gives healthcare payers the flexibility to grow their business without concerns for technology constraints
• Allows payers to mitigate operational risk by pursuing a phased approach to legacy system replacement
• Enables payers to reduce their reliance on scarce IT resources by authoring easily configured business rules rather than relying on custom coding
• Makes the consolidation of back-office claims operations easier and more cost effective
• Improves payers' ability to give members and providers access to information such as utilization and claims history for individuals and families, or details on benefit limitations
• Provides a consolidated and comprehensive view of benefits utilization even when some claims are processed by other systems