Harvard Pilgrim Launches Claims Adjudication Solution

Harvard Pilgrim Health Care Inc., a private health plan, will go live this month with the first phase of its new claims adjudication solution implemented on the Oracle Health Insurance claims application.

Oracle says the application is expected to process about 1 million claims transactions per month and increase auto-adjudication rates for Harvard Pilgrim's members throughout New England. This will lead to faster, more automated claims processing and reduced operating expenses. The application will keep a record of all claims transactions, including outsourced benefits administered via partner platforms, giving Harvard Pilgrim a 360-degree view of member benefits and provider services, according to Oracle.

Harvard Pilgrim has integrated the Oracle Health Insurance claims application with the Oracle E-Business Suite, helping the insurer standardize payments to health care providers. Payment authorizations flow automatically from the claims application to the accounts payable system, Oracle says, automating what is currently a highly manual process. The system generates audit trails of each transaction to comply with industry regulations.

The application is adaptive and rules-driven, enabling Harvard Pilgrim to adapt to business needs by reconfiguring business rules, rather than having Oracle re-program the underlying code, the company adds.