Oracle’s New Claims Processing Platform Aims to Change Healthcare Business

Oracle has debuted a cloud-based solution designed to streamline medical claims processing.

Oracle Health Clinical Data Exchange is designed to replace the manual transmission of medical records with a secure, centralized network to reduce administrative time and costs, according to a Monday (Oct. 14) press release.

“Healthcare has long been plagued by costly, time-intensive, and antiquated claims processing that results in billions of unnecessary fees each year, and ultimately a strained relationship between providers and payers,” Seema Verma, executive vice president and general manager, Oracle Health and Life Sciences, said in the release.

“Oracle Health Clinical Data Exchange helps eliminate this burden by simplifying and automating tedious and inefficient manual processes. It frees up valuable provider time, helps payers get more accurate and complete clinical information, and accelerates care approvals and reimbursements.”

The release estimates that about 70% of authorizations are done by phone or fax and just a quarter of documents related to reimbursement are shared digitally between payers and providers, adding significant processing time for reimbursements and delaying care.

“The challenge for providers is escalating as the volume of clinical data requests from payers is growing annually,” Oracle said.

With the data exchange, the release said, providers control their data and can pick what data to make accessible to their payer partners for strong data governance. Providers can also audit selected clinical data with chosen payers to confirm exactly which data was received to ensure policy compliance.

“Using Oracle Health Clinical Data Exchange, payers retrieve clinical data via FHIR queries or bulk processing in an industry-standard format familiar to payers,” the release said. “Oracle Health’s centralized exchange enables payers and providers to establish a presence on the network once and share data with any other participant. No additional point-to-point connections are required.”

Research by PYMNTS Intelligence has shown that many healthcare organizations say that inefficient systems threaten their financial health. More than half of payment leaders say they are worried about delays in processing payments and claims, which they see as substantial operational risks.

“While 80% believe streamlining these processes is crucial, only 53% have adequately automated their workflows, indicating a reliance on manual methods that result in costly errors and lost revenue,” PYMNTS wrote last month. “Consider 84% of organizations report financial losses due to outdated accounts receivable processes, and 85% recognize the urgent need to improve payment experiences, emphasizing the demand for a comprehensive overhaul.”

Making matters worse is a reliance on traditional paper statements, with close to 70% of providers still using paper for patient communications, while 50% cite that as a major concern in managing revenue cycles.

“This antiquated practice not only hampers timely collections, but also prevents healthcare providers from tapping into the efficiency gains offered by digital payment solutions,” wrote PYMNTS.