Navigating a path forward in the new normal

A flexible, layered model

Oracle has developed a layered model that allows for Oracle to build and maintain localisation features and yet have customers extend these to create their own IP, and maximise brand differentiation.

Oracle health insurance core product

Provides Australian market capabilities such as age based discounts, LHC, and Medicare rebate. Plus core capabilities of membership, provider contracts, claims pricing and adjudication. Delivered as a SaaS service, maintained by Oracle.

OHI configuration layer

The majority of market specific features includes data attributes commonly used in Australia, as a cohesive model to ensure speedy compliance with market changes. These include things such as rate and rebate tables, market specific claim rules, and integrations and extracts to external service providers, or agencies like the ATO.

Customer specific configurations

Includes a variety of information such as custom codes, product & benefit designs, premium schedules, claims processing rules, fraud waste and abuse rules and more. This is client retained IP and is never contained within our core product.

Localisation artifacts

Oracle’s investment in Australian market localizations is extensive. As a result, the Oracle Health Insurance solution provides all required functionality as pre-built configuration.

Common configuration

Based on publicly available specifications or requirements and will be documented and supported by standard product support mechanisms. Localisation’s will be delivered as core product functionality. An Example is ‘Date Paid to’.

Interpreted configuration

Localisation with reliance on 3rd party end points/data sets or a mixture of industry and fund specific business rules. This is documented as a configuration set, and an implementation asset for use in customer onboarding and support. An example is claims processing rules for eclipse hospital claims.

Active customer advisory board

Oracle works closely with customers in support of innovation. Our CAB extends beyond advancement of the OHI application and Oracle technology, into partnerships that provide customers access to insight and innovation that only Oracle can provide via global industry relationships.

Harness true innovation

Maximise brand differentiation and harness capability to innovate and deliver at speed, with not only the configurability and flexibility of the OHI platform, but through integration of additional technologies and value propositions.

Plug and play added value

Oracle supports readily available value add solutions covering a whole host of industry specific areas. Such as Health and Wellness, quantification of health, blockchain, telehealth, AI driven claims excellence, OCR, HL7 FHIR and much more.

Componentized, comprehensive, administrative capabilities

As a modular PHI solution specifically for health payers, Oracle’s ‘Insurer in a box’ furthers the concept by bundling additional functional modules commonly required to confidently migrate from legacy. E.g. CRM, CCM, IFRS17, Analytics and more. Take one, some, or all, progressively, depending on requirements.

Maximise data interoperability

With a comprehensive RESTful API layer, 150+ industry specific integration points and the powerful Oracle Insurance Gateway, OHI’s integration and data interoperability capability ensures data gets to where it’s needed, when it’s needed.

Manage change at speed

Configurability is what has allowed OHI to localise for the Australian market, but is also what gives insurers confidence to manage change, at speed moving forward. Tackle market and regulatory change in your stride, and not at the expense of growth.

True insurance cloud services

Complete and comprehensive PHI administrative capability, on Australian based cloud, as a service. Designed for Australian Health Insurers, with 3 upgrades a year on highly available single tenant environments. Let Oracle keep the lights on while you deliver for members.