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Better Revenue Management

Control revenue leakage and take advantage of an adaptive revenue management solution that enables you to capitalize on new opportunities, respond to regulation, 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
Better revenue management

Product Features for Revenue Management and Billing

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Enterprise Pricing

  • Comprehensive and flexible capabilities for constructing various pricing models based on the potential customer relationship
  • 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 or federal business rules

Enterprise Billing

  • Supports multicurrency, real time/batch/event-based accurate billing with flexible bill cycles
  • Enables maintaining complex billing hierarchies for large groups and national accounts for variety of health plans
  • Segments bills and increases productivity with high level of automation, centralized control, and error-free outcomes
  • Provides rules-driven billing approach to enable true business agility and revenue recognition

Unified View

  • Supports centralized processing and monitoring with a 360-degree customer view
  • Out-of-box integrations with enrollment systems through inbound web services
  • Improves efficiency with unified processing and monitoring
  • Improves productivity and customer service with visibility of the entire customer relationship

Reconciliation and Payment Settlement

  • Reduces operational cost and improves straight-through processing
  • Supports real-time payment settlement and seamless processing
  • Improves customer experience and helps achieve faster reconciliation
  • Provides capabilities for managing delinquency, discrepancy, and notifications to reduce risk, along with built in AR/AP and subledger capability

Deep Insights

  • Define who to charge (all entities involved in transaction) and what to charge ( all the price items, charge codes, products, services)
  • An unlimited number of rules to map transactions under a variety of situations such as one-to-one, one-to-many, many-to-one and many-to-many

Accelerated time to market

  • 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

Superior Experience

  • Create multidimensional customer group hierarchies and apply pricing and billing preferences
  • Provides visibility into billing data and enhances predictive decision-making

Multiparameter-based pricing

  • Flexible charging structure: pay-as-you-go, unit-based, transaction-based, and subscription-based pricing models
  • Charge based on the value of customer relationship and in the context of the customer’s buying pattern and circumstances
  • What-if modeling capabilities to assess alternative rate structures against margin goals