Harvard Pilgrim Health Care Selects Oracle Health Insurance for Claims Adjudication Solution

By Calvin Azuri
TMCnet Contributor

Oracle (News - Alert) Health Insurance has been selected by Harvard Pilgrim Health Care, Inc., the top commercial health plan in America for five consecutive years, according to U.S. News & World Report and the NCQA, to build its core claims adjudication solution.

Oracle's European health insurance market experience, in combination with intellectual property with the Oracle Insurance rules-based adaptive application strategy, will result in the Oracle Health Insurance claims solution. The foundation for the next generation of core Oracle Health Insurance applications is provided by this combination, and the configurability required to address critical time-to-market issues is delivered by this solution. New health benefits and those resulting from United States regulatory changes can therefore be addressed.

Numerous integration points are offered by the service-oriented architecture or SOA-based solution. A phased approach to system replacement has also been provided. Harvard Pilgrim can therefore simplify and extend its existing multi-claims platform environment and reduce the total cost of IT systems ownerships by reducing system integration and custom coding requirements.

The solution will automate claims adjudication for all types of claims and alternative reimbursement models. Comprehensive processing capabilities driving down claims and processing costs will therefore be enhanced. Based on the solution's integration with Harvard Pilgrim's Oracle E-Business Suite, critical back-office processes will be streamlined.

By 2013, it will be mandatory to adopt the International Statistical Classification of Diseases and Related Health Problems 10th Revision or ICD-10 in the US. The ICD-10 mandate is supported by the new Oracle solution.

"Oracle Insurance welcomes the opportunity to collaborate with Harvard Pilgrim in a collaboration that represents our entry into the U.S. core health insurance applications market -- an area in which Oracle Insurance sees extensive room for growth as insurers seek solutions to help them navigate major industry changes,” said Michiel Walsteijn, senior director at Oracle, in a release. “With Harvard Pilgrim, we will bring to life our vision of the adaptive health insurer, one that can be nimble and profitable while managing regulatory change."

The Oracle solution will be implemented with Dell (News - Alert) Services in collaboration with Oracle. Dell Services is the technology and business process outsourcing partner of Harvard Pilgrim.