Oracle Revenue Management and Billing for Health Insurance Payers

Transform health insurance pricing and billing operations across all lines of business with a single scalable solution. Improve agility to meet ever-changing market requirements and drive increased revenue assurance.

Enhance Healthcare Billing with Oracle Revenue Management and Billing Trial

A one-stop enterprise solution

  • Fully insured (individual/group)

    Maximize product innovation and meet rigorous member expectations.

  • Government plans (Medicare/Medicaid)

    Meet ever-changing regulatory requirements, complex subsidy adjustments, and expanding member expectations.

  • Self-funded and ASO

    Manage group health expenses and cash flow smartly and provide organizations with cost-effective models.

  • PBM and specialty services

    Drive revenue assurance with complete end-to-end transparency and flexible billing for pharmacy rebates and other value-added services.

Kaiser Permanente testimonial video thumbnail

Transforming Healthcare Billing: Kaiser Permanente’s Journey with Oracle

Kaiser Permanente, a healthcare giant, tackled the challenge of outdated 1990s and early 2000s legacy systems by upgrading for stability, security, and efficiency with Oracle. Their journey showcases the transformative impact of implementing the Oracle Revenue Management and Billing system (ORMB).

Explore the features of Oracle Revenue Management and Billing for health insurance payers

Robust premium calculation engine

Automate pricing for all lines of business—fully insured group or individual, self-funded, government plans, and more—with out-of-the-box capabilities for calculating premiums and fees based on eligibility definitions and qualifying events.

Flexible billing

Enable business agility with an automated, rules-driven approach that supports accurate real-time and batch billing with flexible bill cycles.

Reconciliation and settlements

Improve revenue recognition through flexible accounting processes and subledger mappings. Enable real-time payment processing and automated reconciliations.

A unified view, enabling superior member experiences

Achieve a complete view of each member by consolidating billing across multiple lines of business. Ensure an enhanced contact centre experience by leveraging a dedicated Billing 360 portal that offers easy access to all financial transactions.

Preconfigured with best-in-class processes

The ready-to-use solution is based on prebuilt workflows and processes, driven by industry best practices, and augmented by the ability to add business-specific configurations.

Integration and scalability

Seamlessly integrate with ecosystem applications by leveraging the extensive API library. Scale rapidly on the cloud to meet the needs of your growing business.

Why choose Oracle Insurance Revenue Management and Billing for health insurance payers?

01Optimize pricing and billing operations

Boost operational efficiency across all lines of business with a single, centralized, and fully automated billing solution.

02Maximize revenue assurance

Leverage a flexible and configurable billing solution that can bill a wide range of charges and supports innovative fee types and payment reconciliation.

03Elevate customer engagement

Gain a holistic view of the customer, support flexible payment modes, and expand self-service capabilities.

04Boost scalability and business readiness

Easily support new forms of coverage and revenue models. Handle groups and memberships of all sizes, even as billing volumes expand.

We can help improve operational efficiency and optimize member service.

Find resources and more

Navigating New Challenges in Medicare Rx Drug Billing

The Inflation Reduction Act adds relief and complexity to healthcare by capping Medicare Part D expenses. This webinar delves into adaptive billing techniques that can help you align with legislative changes and ensure compliance and financial efficiency. Join experts from IDC, OptumRx, and Oracle for insights into how to proactively navigate changes, optimize billing, and safeguard against new Medicare regulations.

Watch the webinar (59:43)

The case for modernizing enrollment and billing capabilities

Healthcare payers are moving away from monolithic software systems toward componentized systems, but a debate has emerged: When you separate enrollment from billing, which capabilities should each consider as core competencies?

Read the business brief (PDF)

Oracle Revenue Management and Billing for Healthcare Payers Newsletter, Vol. 5

Explore trends shaping the health insurance industry and how digital technologies can drive efficiencies.

Read the Vol. 5 newsletter (PDF)

Oracle Revenue Management and Billing for Healthcare Payers Newsletter, Vol. 4

Discover the tools and techniques payers need to manage diverse processes for payments, detail billing, and delinquency management.

Read the Vol. 4 newsletter (PDF)

Get started with Oracle Revenue Management and Billing for healthcare insurance payers

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