Oracle has released Insurance Claims Adjudication for Health, a highly configurable, rules-driven claims system that helps payers reduce administrative costs and increase member and provider satisfaction. The application enables health care payers to easily configure business rules to process more complex claim scenarios automatically, increasing consistency in claims payments while reducing the number of claims processed manually.
Oracle says more accurate first-pass adjudication of claims can be achieved, reducing the number of claims requiring manual review and, thus, lowering administrative costs.
The product also allows for the creation of business rules to reflect the benefits offered; acceleration of payments to providers and members; and avoidance of payment adjustments by automatically detecting and flagging potential errors across all claim types. Payers also can change quickly the software’s settings to meet new regulatory requirements and support new products or benefits.
The solution supports major medical, dental, vision and behavioral health claims. The application is designed to scale for very high volumes to support consolidation of various claims engines into a single instance.
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