Payer operations

Deliver transparency and ease friction

Facilitate near real-time data exchange, minimize administrative complexity, and strengthen payer-provider collaboration with Oracle Health’s intelligent, data-driven solutions to support enhanced member experiences.

Alleviating payer-provider friction with AI

Explore how Optum and Oracle Health are using AI to transform payer operations.

Payer operations solutions

Promote transparency, simplify operations, and ease collaboration between payers and providers. Support clinical data exchange, streamline coding and care gap closure recommendations, and help enhance care coordination and member experiences with integrated solutions.

Streamline clinical data exchange between payers and providers

Leverage a centralized network that enables payers and providers to share clinical data easily and securely.

Clinical data exchange

Oracle Health Clinical Data Exchange streamlines payer-provider clinical data sharing through an automated, centralized, and secure nationwide network. By efficiently delivering essential EHR patient encounter data, it limits the need for multiple custom electronic connections or manual interactions between payers and providers.

Deliver recommendations to help close coding and quality gaps

Surface actionable insights and push coding and care gap closure recommendations to providers at the point of care to support data-driven decision-making.

Coding gap closure

Coding gap closure recommendations support coding accuracy by routinely validating patient conditions to help identify appropriate hierarchical condition category codes.

Quality gap closure

Quality gap closure recommendations help facilitate preventive and proactive care coordination. Payers can send recommendations to providers via push notifications to support evidence-based treatment.

Streamline operations and administrative processes

Minimize costs, enhance member experiences, and respond to evolving market needs by automating, coordinating, and optimizing essential administrative tasks.

Health insurance

Oracle Health Insurance enables health insurers, health plans, and third-party administrators to drive operational efficiencies, minimize administrative costs, and enhance member experiences. Our solution helps organizations efficiently manage core administration operations such as policy administration, claims processing, member management, billing, and provider network management.

The Oracle Health advantage

Operate with confidence and efficiency. With ready-to-deploy, modular solutions, enterprise-grade security, and embedded intelligence, our solutions are designed to help simplify operations and optimize performance. Discover what makes us different.

All in one, ready to deploy

Streamline operations with our unified platform, which offers core functionality and out-of-the-box, modular solutions that flex to help meet your needs.

Intelligent by design

Drive informed decision-making with embedded intelligence built into every workflow, empowering you to keep pace with evolving industry standards.

Built-in security

Keep your data protected with enterprise-grade security that’s trusted worldwide, and transact directly with providers, not through third-party intermediaries.

Rapid transactions, expansive connections

Drive operational efficiencies and support member outcomes with near real-time connections and access to a vast provider network.