Product Features for
Oracle Insurance Revenue Management and Billing for Healthcare Payers
Simplify Complex Pricing Situations
- Comprehensive and flexible capabilities for constructing various pricing models
- Automates pricing for multiple lines of business at a lower cost of ownership
- Out-of-box capabilities for ASO: admin fees, stop loss, level funding arrangements
- Out-of-box capabilities for calculating premiums and fees based on qualifying events like member addition, termination, etc., that are based on state level or federal business rules
- Parameter-based pricing variations
- Adjusts the price on specific products and tailors offers based on the potential customer relationship
Increase Productivity with Accurate Billing and Accounting
- Supports multi-currency, real time/batch/event based accurate invoicing
- Ad-hoc as well as scheduled billing with flexible bill cycles: monthly, quarterly, annual
- Enables maintaining complex billing hierarchies for large groups and national accounts
- Consolidates billing for variety of health plans and enables a simplified experience across multiples lines of business/groups or individuals
- Bill review process based on business rules
- Segments bills and increases productivity with high level of automation and error-free outcomes
- Supports complex transactions with centralized control for systematic refunds and adjustments
- Provides rules-driven billing approach to enable true business agility and revenue recognition
Streamline and Centralize Processes
- Supports centralized processing and monitoring for consolidated multiple enrollment channels and a 360-degree customer view
- Out-of-box integrations with enrollment systems through inbound web services; file upload interface utility for real-time as well as batch bulk updates
- Improves efficiency with unified processing and monitoring
- Improves productivity and customer service with visibility of the entire customer relationship
Achieve Unified and Responsive Payments
- Reduces operational cost and improves straight-through processing
- Supports real-time payment settlement and seamless processing
- Improves customer experience and helps achieve faster reconciliation
- Reconciliation and discrepancy management
- Payment application based on rules
- Provides capabilities for managing delinquency, discrepancy, and notifications to reduce risk
- Supports standard messaging and a variety of payment methods
Develop Insight-Driven Approach
- Enables informed decision making with high fidelity insights
- Provides out-of-the-box analyses, including metrics, charts, and reports
- Allows for consistent, real-time dynamic billing and pricing decisions
Gain Superior Customer Experience
- Helps create multidimensional customer group hierarchies and applies pricing rules and billing preferences at any level of the hierarchy
- Provides visibility into billing data and enhances predictive decision-making