New Oracle Application Helps Health Insurance Members and Providers Get Paid Quickly and Easily
January 18, 2012
By Deborah Hirsch
TMCnet Contributor
Oracle (News - Alert) today introduced a rules-driven claims system that helps payers reduce administrative costs and makes it easier for both members and providers to file claims, and more important, be paid, according to a company press release.
Oracle Insurance Claims Adjudication for Health allows healthcare payers to do a number of things, including easily configure business rules to make claims payments more consistent, while reducing the number of claims processed manually; reduce the number of claims requiring manual review and thus lowering administrative costs; create a system to avoid manual errors that can lead to payment of claims in the wrong amount; speed up payments to providers and members, “and avoid payment adjustments by automatically detecting and flagging potential errors across all claim types,” according to the press release.
The application also provides a “user-friendly” approach, by no longer requiring custom code or changes to software settings to meet new regulatory requirements and support new products or benefits.
Using the application, insurers can create rules governing procedure, diagnosis, provider, facility and custom codes, according to the press release.
Oracle Insurance Claims Adjudication for Health integrates easily with financial systems such as its own Oracle E-Business Suite – for end-to-end claims processing and payment.
Back in 2002 insurers began to recognize the value of rules-driven claims systems, according to Craig Weber at celent.com, and the ability of technology upgrades to help make them extremely important for insurers. He estimated that a carrier that writes 40,000 policies a year could save over $1 million, while giving insurers access to and control of their data.
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Deborah DiSesa Hirsch is an award-winning health and technology writer who has worked for newspapers, magazines and IBM (News - Alert) in her 20-year career. To read more of her articles, please visit her columnist page.
Edited by Jennifer Russell
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