Oracle Health tackles payer-provider friction
Oracle Health introduced a suite of artificial intelligence-based tools aimed at improving coordination and reducing administrative burden between healthcare providers and payers.
The company announced the suite at the Oracle Health and Life Sciences Summit Sept. 11. The suite is designed to streamline high-friction processes including prior authorization, eligibility verification, medical coding, claims processing and denial management. Embedded AI agents can apply payer-specific rules during provider workflows to improve claim accuracy and reduce delays. The offerings include a prior authorization agent, eligibility verification agent, coding agent and multiple claims processing agents.
The rollout comes as the industry faces about $200 billion in annual administrative costs tied to billing and insurance, driven largely by manual processes and complex rule sets. Oracle Health said its tools will automate data entry, apply medical necessity criteria, and improve accuracy in charge capture and reimbursement coding.
Initial applications will focus on reducing the cost and complexity of prior authorizations, eligibility checks and claims submission. The technology is also expected to accelerate payer responses and reduce denials by allowing provider systems to integrate payer logic into clinical workflows.
“Oracle Health is working to solve long standing problems in healthcare with AI-powered solutions that simplify transactions between payers and providers,” said Seema Verma, executive vice president and general manager, Oracle Health and Life Sciences. “Our offerings can help minimize administrative complexity and waste to improve accuracy and reduce costs for both parties. With these capabilities, providers can better navigate payer-specific coverage, medical necessity, and billing rules while enabling payers to lower administrative workloads by receiving more accurate claims from the start.”
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