Harvard Pilgrim Health Care has selected Oracle Health Insurance Claims solution to build its core claims adjudication solution.
The solution combines the Oracle’s European health insurance market experience and intellectual property with the Oracle Insurance rules-based adaptive application strategy.
The solution can be configured to adopt new and critical time-to-market issues for implementing new health benefits as well issues resulting from US regulatory changes.
The service-oriented-architecture (SOA)-based Oracle Health Insurance Claims solution offers various integration points and a phased approach to system replacement, enabling Harvard Pilgrim to simplify and extend its existing multi-claims platform environment, reducing system integration and custom coding requirements.
Claims adjudication for all types of claims and alternative reimbursement models will be automated in the solution. The back-office processes will be streamlined based on the solution’s integration with Harvard Pilgrim’s Oracle E-Business Suite.
According to the Oracle, the solution supports the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10), which is mandated for adoption in the US by 2013.
Harvard Pilgrim Health Care chief information officer Deborah Norton said that Oracle’s European solution for claims adjudication, currently the dominant application in The Netherlands, addresses that hybrid public/private market with a uniquely flexible solution.
“Oracle’s proposal to combine this with a native service-oriented-architecture approach provides Harvard Pilgrim with a timely and compelling solution,” Norton said.