Harvard Pilgrim Health Care, Inc., the number one private health plan in America for eight straight years, according to the National Committee for Quality Assurance (NCQA), will go live this month with the first phase of its new claims adjudication solution implemented on the Oracle Health Insurance claims application.
The new claims application is expected to process about one million claims transactions per month and increase auto-adjudication rates for Harvard Pilgrim's members throughout New England—leading to faster, more automated claims processing and reduced operating expenses. Cost reduction is an important consideration for U.S. healthcare payers under reforms, which requires that payers keep administrative expenses below mandated guidelines.
The Oracle Health Insurance claims application will keep a record of all claims transactions, including outsourced benefits administered via partner platforms, giving Harvard Pilgrim a 360-degree view of member benefits and provider services and further increasing the company's reputation for providing outstanding service.
Harvard Pilgrim has integrated the Oracle Health Insurance claims application with the Oracle E-Business Suite, helping the insurer standardize payments to healthcare providers. Payment authorizations flow automatically from the claims application to the accounts payable system, automating what is currently a highly manual process, and the system generates audit trails of each transaction to comply with industry regulations.
In addition, the Oracle Health Insurance claims application is adaptive and rules-driven, letting Harvard Pilgrim meet rapidly changing business needs by reconfiguring business rules rather than having Oracle reprogram the underlying code. This is expected to help Harvard Pilgrim quickly support innovative products and services to keep pace with a dynamic, rapidly changing healthcare environment.
The Oracle Health Insurance claims application leverages the same technology foundation that provides the framework for Oracle Fusion Applications, allowing for ease of integration into a client's existing processing landscape.
Built on a service-oriented architecture, the Oracle Health Insurance claims application enables a phased implementation, hence avoiding a "big bang" system replacement and substantially reducing project risk.
"With this project, we expect to achieve three goals," said Eric Schultz, President and Chief Executive Officer, Harvard Pilgrim Health Care, Inc. "One is to respond to the needs of the marketplace by keeping health care as affordable as possible Secondly, we want to reduce expenses—healthcare insurance is a highly competitive business, and our ability to reduce our operating costs by even a point or two is a huge competitive advantage. And finally, we want to process millions of transactions every year consistently and accurately, so we can continue to provide the best service possible to our members and support our innovative product and provider strategy. This is core to our mission, and the Oracle claims engine is helping us to achieve it."
"Our objective at Oracle Insurance is to provide flexible, rules-driven systems that help insurers meet their business goals—rapid introduction of new products, efficient customer service, compliance with industry regulations, and effective performance management," said Don Russo, Senior Vice President, Oracle Insurance. "We're very proud to be part of helping Harvard Pilgrim Health Care achieve these business goals. With our new health insurance claims application expected to be widely available this year, we look forward to helping other healthcare payers achieve similar success."
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About Harvard Pilgrim
Harvard Pilgrim (harvardpilgrim.org) is a not-for-profit health plan that provides a variety of health benefit options and funding arrangements to more than one million members in Massachusetts, New Hampshire and Maine. Harvard Pilgrim has been named the #1 private health plan* in America for the eighth consecutive year** according to an annual ranking of the nation's best health plans by the National Committee for Quality Assurance (NCQA).
** NCQA's Private Health Insurance Plan Rankings, 2011-12
NCQA's Health Insurance Plan Rankings 2010-11 – Private. U.S. News/NCQA America's Best Health Insurance Plans 2005-2009 (annual). America's Best Health Insurance Plans is a trademark of U.S. News & World Report. NCQA The State of Health Care Quality 2004.
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Mary Tobin, O'Keeffe and Company
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