Reduce Medical Loss Ratio by Straight-Through-Processing with Oracle Health Insurance Components

With the steady increase of healthcare costs, health insurance payers are challenged to find new ways to reduce cost. As a payer, you have three ways to achieve this: reduce reimbursement, reduce coverage or reduce the cost of running your business. The first two options shift the cost towards providers and members and are not viable in a competitive marketplace. Making the third option – reducing the medical loss ratio – an attractive choice. Any payer strives towards a claims administration where straight-through-processing is the norm. Yet, not many payers get to boast auto-adjudication rates higher than 95%. In fact, many payers do not even come close. And given the volume of claims in health insurance, even if you achieve an autoadjudication rate as high as 95%, that still means you have to deal with (tens of) thousands of claims that can’t be processed without some kind of intervention. Learn how Oracle Health Insurance Components can boost auto-adjudication and give you the flexibility you require to achieve operational excellence. July 2015.