Oracle Health Accelerates Claims Processing with Automated Data Exchange between Healthcare Providers and Payers

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Oct 14, 2024, 08:30 ET

Oracle Health Clinical Data Exchange helps reduce costly and time-consuming manual processes, to deliver efficiency gains for payers and providers

AUSTIN, Texas, Oct. 14, 2024 /PRNewswire/ -- Oracle today announced general availability of Oracle Health Clinical Data Exchange, a new, cloud-based solution that streamlines medical claims processing through secure, automated data exchange between healthcare providers and payers. Built on Oracle Cloud Infrastructure (OCI), Oracle Health Clinical Data Exchange replaces today's laborious manual transmission of medical records with a secure, centralized network that helps reduce administrative time and costs, speed approval of necessary patient clinical services, and accelerates claims and payment processing. Oracle Health Clinical Data Exchange is the first step towards offering payers a comprehensive platform to enable instant claim evaluation and processing and improve clinical decision making.

"We're excited to begin using this new Oracle Health solution, which we expect to help us more easily and securely respond to payer data requests, and ultimately ease the current burden on our staff," said Kent Hoyos, vice president and CIO, Information Services, Pomona Valley Hospital Medical Center. "Automating the process will help speed approval of necessary patient clinical services as well as payment processing and shorten the wait time for our patients to receive the care they need."

Today, it is estimated that about 70% of authorizations are done by phone or fax and only about 25% of documents related to reimbursement are shared digitally between payers and providers. This adds significant processing time for reimbursements and can cause delays in patient care. The challenge for providers is escalating as the volume of clinical data requests from payers is growing annually. Oracle Health Clinical Data Exchange helps tame clinical data administration chaos, moving providers and payers from outdated manual processes to faster payer responses and claim reimbursements, helping patients receive more timely care.

"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," said Seema Verma, executive vice president and general manager, Oracle Health and Life Sciences. "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."

Putting Patient Privacy and Data Security First
Powered by OCI, Oracle Health Clinical Data Exchange takes advantage of the same military-grade cybersecurity capabilities used to protect data at some of the largest and most sophisticated businesses, national defense agencies, and governments around the world. Providers control their data and can select what data to make accessible to their payer partners to maintain strong data governance. To support policy compliance, providers can audit selected clinical data with chosen payers to confirm exactly which data was received. Using Oracle Health Clinical Data Exchange, payers retrieve clinical data via FHIR queries or bulk processing in an industry-standard format familiar to payers. 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.

Customers can sign up for Oracle Health Clinical Data Exchange by raising an SR in eService. Providers using Oracle Health's electronic health record (EHR) can easily onboard selected payers to Oracle Health Clinical Data Exchange at no additional charge.

Find out more about it at the Oracle Health Summit in Nashville on Oct. 29-30, 2024. The event brings together global healthcare leaders to discuss how to tackle industrywide challenges and apply new innovations.

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SOURCE Oracle