Oracle Health Insurance Cloud Services

Oracle Health Insurance Claims Administration Cloud Service offers the following features:

• Set-up claims benefit configuration
• Claims intake, claims reserving, match referrals and authorizations
• Automated claims administration and benefit calculation, accumulators, claims financials or settlement, subrogation and salvage, appeals or grievances and legal, claims case management, claims documents
• Set-up service detection, duplicate detection
• Automated pricing and pricing adjudication, provider-based accumulators, callouts to external editors
• Set up configurable rules and callouts to claims systems
• Automated process flow for authorization validation
• Set up capitated contracts and service provider contracts for capitation and other non-fee for service arrangements
• Automated value-based payment calculation

Oracle Health Insurance Policy Administration Cloud Service offers the following features:

• Product and plan configuration, group set-up, insured or member administration
• Pricing (premium calculation)
• Policy issuance or group enrollment, re-insurance, policy recordkeeping
• Membership and enrollment maintenance
• Set up capitated contracts and service provider contracts for capitation and other non-fee for service arrangements
• Automated value-based payment calculation