Clinically driven and patient-focused—that’s the foundation of Oracle Health’s revenue cycle management (RCM) solutions. A clinically driven revenue cycle takes information captured by clinicians during care and uses it to drive financial outcomes.
Gathering complete and accurate information from patients is a necessary step in managing your organization’s cash flow. Oracle Health can help your organization facilitate patient engagement and access by prioritizing the patient experience.
Oracle Health Scheduling Management workflows help ensure patients are scheduled for the appropriate appointment to receive the right care at the right time by efficiently taking into consideration patient preferences, insurance specifications, and venues.
Oracle Health Registration Management solution provides users with a broad range of tools and workflows while simplifying the registration user experience based on venue, role, and operational procedures.
Our financial clearance workflows, within Registration Management, help minimize the amount of information patients are asked to verify during preregistration or on arrival by evaluating whether the data is accurate and up to date, helping to improve the overall preregistration and intake experience.
Start creating a compassionate care experience at the first patient touchpoint.
Improve utilization management and care transition planning. Our Acute Case Management software can transform how your teams collaborate with each other and your patients as they perform clinical reviews and care transition planning activities in a connected, clinically driven revenue cycle system.
Increase coding workflow efficiencies, automate chart completion, and simplify the release of information process. Our HIM solutions help you limit workflow fragmentation in your coding environment with a single platform that connects your clinical information to a third-party encoder to streamline billing processes.
Our back-office RCM solutions support billing, charge capture, claims and AR management, and contract management across care venues. Efficient back-office workflows help your teams focus on what’s most important and limit the burden of manual administrative work.
Bring simplicity to your revenue cycle team and patients. Our solution helps facilitate services being reimbursed in an accurate and timely manner with efficient back-office workflows across venues of care.
Improve ambulatory patient engagement. Our practice management solution is designed to connect with our EHR so users can navigate between the various aspects of practice management—including scheduling, registration, patient tracking, patient accounting, patient engagement, and reporting—all within a single application.
Streamline the management of payer contracts across billing and contract management. Our Contract Management solution uses logic—based on the payer—to calculate expected reimbursement as charges are captured and identify payment variances.
Leverage our trusted clearinghouse services to help facilitate accuracy and gain access to information that leads to a patient-friendly revenue cycle experience. Our healthcare network connects providers, payers, and other healthcare entities to facilitate interoperability throughout the revenue cycle. Healthcare data exchange aims to address the administrative complexities of healthcare by providing payer information in a way that complies with regulatory requirements.
Control revenue leakage and take advantage of an adaptive revenue management solution that helps you capitalize on new opportunities, respond to regulation changes, and improve operational efficiencies.
Oracle Insurance Revenue Management and Billing
Our system helps insurers simplify healthcare IT, improve operational efficiency, reduce costs, and adapt quickly to ongoing market and regulatory demands.
Gain the flexibility to manage business rules for different lines of business, provide a enhanced member experience, create products quickly, grow enrollments, and increase market share with a secure, affordable cloud platform that scales to meet the needs of healthcare organizations of all sizes.
Respond faster to market and regulatory changes by limiting the need for source code changes. Improve operational efficiencies and bring new products to market faster through collaborative product development.
Improve the enrollment experience with faster premium calculations, enhanced policy administration, advanced benefits adjudication, and accurate billing that can be deployed on-premises and in the cloud.
Lower health insurance claims management costs significantly by automating processes, and increase auto-claims adjudication rates using a business rules–driven workflow.
Our technology can use HL7 as well as APIs. These connections help streamline the user experience, and in some cases, provide advanced capabilities by combining Oracle Health data with partner data in ways that can drive decision-making and improve workflows.
Review our current list of preferred supplier partners. However, if you have different third-party tools, patient access has the ability to connect through HL7 interfaces and APIs. The open developer experience (code) site has resources that can assist your support teams in leveraging the APIs Oracle Health has made available.
The open developer experience program encourages innovators to build apps that advance the healthcare industry through improved interoperability capabilities. Using Ignite APIs allows us to scale and better support our API-enabled innovation and healthcare market. Third-party and client developers will find this approach gives the applications they develop extensibility.
Patient access uses a single patient record to keep care, demographic, and historical documentation linked for clinical decision-making and consumer personalization. With an enterprise master person index, your teams can identify and resolve duplicate records to facilitate the integrity of a single person record. Advanced automation capabilities are available with the HealtheIntent Master Person Management (MPM) API, which can help identify and combine your patient records.
Oracle Health Acute Case Management can add value to any customer, including general short stay acute hospitals and health systems, children’s hospitals, rehabilitation hospitals, and critical access hospitals, as well as behavioral health and development facilities in long-term and post-acute care venues.
Extending Acute Case Management to the post-acute space builds on what’s already available as a product and can be licensed now for use in other venues of care. We’re constantly evaluating use cases for any venue that’s capturing medical necessity criteria and care transitions for the benefit of the caregiver and the safety of the people in the community.*
* All solutions/services are under development. Oracle Health makes no assurances that the capability described herein will be provided in the solution/services.
Acute Case Management supports case managers, utilization nurses, documentation specialists, discharge or care transition planners, social workers, and other clinical roles supporting readmission prevention, denials, and appeals, as well as multidisciplinary teams focused on utilization, length of stay, and care transition planning.
For utilization management, clients can choose to use either InterQual or MCG Health medical review guidelines within Acute Case Management. Medical review guidelines are not sold by Oracle Health. Clients will need a separate license with InterQual or MCG Health prior to embedding content and launching the third-party applications within Acute Case Management.
For care transition planning, Acute Case Management has invested in embedding naviHealth's nH Discharge and Ensocare Transition to support care transitions for patients discharged from acute care and needing post-acute care placement and services. Oracle Health resells the post-acute care transitions (naviHealth's nH Discharge) and post-acute referrals (Ensocare Transition) solution integration and support.
Oracle Health collaborates with both Optum and 3M to provide seamless use of their encoder solutions using APIs to communicate data in near real time.
Oracle Health supports standard HL7 interfacing to computer-assisted coding and clinical documentation improvement solutions.
The Oracle Health clinically driven revenue cycle enables administrators, care teams, and coders alike to aggregate clinical and financial records into a single patient record and take advantage of clinical automation to help tackle traditionally manual tasks.
Contract management is part of the RevElate Patient Accounting data model and can support both net-down and gross AR reporting. Calculations of expected reimbursement are updated frequently as demographic information, charges, and contracting changes are updated in the revenue cycle system. This way the user has a near real-time view of the applicable contract calculation and terms.
Cerner Patient Accounting has historically been a part of our EHR database infrastructure. With a move to automation, purpose-built data models, and cloud integration components, RevElate Patient Accounting will be the new go-forward patient accounting solution. Due to the volume of clients that need to migrate to RevElate Patient Accounting, the current Cerner Patient Accounting product will continue to receive support and upgrades, including some of the automation capabilities also available in RevElate Patient Accounting. If you’re a current customer interested in more information about RevElate Patient Accounting, please reference our FAQs by logging in with your Oracle Health care account. If you’re a new customer, please contact your sales associate to understand how RevElate Patient Accounting impacts you.
RevElate Patient Accounting is designed to be open and extensible. It can use both traditional HL7 interfaces as well as web-based APIs to connect with third parties.
Claims management services: Helps produce accurate electronic claims. Range of services includes: claims editing and transmission, claim status, secondary billing, audit tracking and note posting for bill date, confirmation notes, and those items identified in the audit tracking process.
Electronic remittance service: Transforms the administration of payment remittance into a process that targets efficiency and cost-saving. When combined with electronic funds transfer (EFT), it supports faster deposit of payments and cash reconciliation.
ePayment: Aims to accelerate the receipt of payments and connects online payment capabilities with our ePayments service.
Integrated eligibility service: Responds to insurance coverage inquiries that help hospitals, clinics, physicians, and other providers verify coverage details and identify requirements that must be completed prior to care.
Integrated notification, authorization, and referrals: Enables electronic referral and precertification inquiries and sends notifications and referral authorization requests through the integrated notifications and referrals Service.
Lock box service: Automates the remittance and posting process of both insurance and patient payments directly to a healthcare's local bank for more timely recognition of revenue and risk reduction of mishandled/lost payments.
Patient anticipated cost of treatment: Targets increasing collections at or before the time of service by estimating patients' financial responsibility.
Patient-friendly statements: Maximizes the efficiency of your business office and supports patient-friendly communications. Provides data transmission and processing, customized formats, and mailing for statements and collection letters.
Payment assessment services: Addresses verification and payment risk assessment solutions that target efficiencies in the registration, financial counseling, and collections workflows.
Web-based and batch eligibility checking: Healthcare data exchange press is a web-based application, HIS-agnostic, and browser-based eligibility verification solution that automates the delivery of results through the automated batch feature.
Healthcare data exchange works with managed care organizations, Blue Cross Blue Shield plans, national commercial plans, regional plans, government plans (Medicare and Medicaid), physicians, physician groups, clinics, hospitals, hospital chains, and integrated health networks. Healthcare data exchange provides electronic data interchange (EDI) services to more than 1,450 of the largest healthcare delivery, acute care, and ambulatory care organizations nationwide, and we currently work with more than 900 payers. Our open network approach enables any healthcare organization interested in participating to join the network while also making it easy to join, both from a business and technical standpoint.
Healthcare data exchange’s vision is to leverage the value of data across health networks to facilitate better outcomes. Healthcare data exchange’s mission is to lead the healthcare community in helping to streamline and prioritize standards, integration, and information exchange by delivering software services that aim to connect and elevate the associate, consumer, client, and partner experience.
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* Parts of Oracle Health RevElate Patient Accounting are under development. Oracle Health makes no assurances that the capabilities described herein will be provided in the product. The legacy Patient Accounting product is still being sold for certain markets, such as Oracle Health CommunityWorks. Oracle Health will work with organizations individually to establish an implementation timeline. Contact your Oracle Health sales associate to understand the path that is best for your organization. Learn more about RevElate Patient Accounting.