Insurance Claims Adjudication for Health Documentation
Release 2.12.4
Welcome to the Oracle Insurance Claims Adjudication for Health documentation library. The Oracle health insurance applications suite provides Claims Adjudication functionality. Claims Pricing uses a calculation that uses Fee schedules, Adjustment rules, Combination adjustment Rules, Provider limits, Formula Based Payment systems in order to implement Fee for Service Pricing, Fee for Service Equivalent Encounters, Per diems, DRG pricing including carve outs. Benefit Accumulator Management provides a central storage for member and provider centric accumulators in a deployment scenario where multiple claims pricing engines and claims adjudication engines run concurrently, while using the same accumulators. Provides single source of truth for member accumulator statements and accumulator status reports.