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Offer Superior Customer Experience

Take advantage of an adaptive flexible solution that enables you to capitalize on opportunities in new markets, respond to legislation, and improve operational efficiency.

Oracle insurance revenue management and billing for healthcare payers

Solution Overview

Oracle Insurance Revenue Management and Billing for Healthcare Payers is a state-of-the-art business service that provides streamlined and automated billing, payments, and collections processes that enable accurate and timely access to billing information and controlling the revenue leakages.

Highlights:

  • Manages multiple lines of business on a single billing platform
  • Supports exchange, individual billing, group billing, ASO billing with stop loss, government plans, and more
  • Minimizes cost and risk via a HIPAA-compliant cloud solution
  • Improves customer satisfaction with timely and accurate billing and transparency
  • Scales to meet the demands of large volumes
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

Government Plans—Medicare and Medicaid


  • Reconcile the payments data in a timely and accurate manner to help healthcare payers avoid revenue loss
  • Rule-based, intelligent design helps capture and process different types of data from multiple sources
  • Easy and automated processing of CMS information