Oracle Health has announced a new suite of AI-powered applications to enhance collaboration between healthcare providers and payers, aiming to streamline prior authorizations, reduce claims denials, and improve care coordination. Unveiled on September 11, 2025, at the Oracle Health and Life Sciences Summit, these solutions address the $200 billion annual administrative cost challenge in healthcare billing and insurance.
Oracle Health launches AI-powered applications for payer-provider collaboration.
Reduces administrative costs, estimated at $200 billion annually.
Automates prior authorizations, eligibility checks, and claims processing.
Enhances care coordination with real-time payer-specific rule application.
Supports value-based care through Oracle Health Data Intelligence.
Integrates with Clinical Data Exchange for secure, efficient data sharing.
Administrative costs in healthcare billing and insurance, estimated at $200 billion yearly, continue to rise due to complex medical and financial rules and reliance on manual processes. Oracle Health’s AI suite targets these inefficiencies by automating key processes like prior authorizations, eligibility verification, and claims processing. “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.”
The suite includes specialized AI agents to address friction points:
Prior Authorization Agent: Automates discovery, documentation, and submission of prior authorization requests, eliminating faxes and follow-up calls.
Eligibility Verification Agent: Provides accurate coverage details to enhance price transparency and reduce surprise billing.
Coding Agent: Generates precise medical codes autonomously, reducing errors with payer-specific guidelines.
Charge, Contract, and Claims Agents: Ensure accurate charge capture and compliant claim submissions, enabling near real-time processing.
These tools embed payer-specific rules into provider workflows, increasing submission accuracy and reducing denials, potentially saving the industry hundreds of millions in administrative costs.
Oracle Health Data Intelligence integrates payer insights into provider workflows to close care gaps and improve value-based care outcomes. The new care and risk coding gaps capability enables payers to share risk coding and quality care data, enhancing HEDIS and pay-for-performance results. The Clinical Data Exchange further streamlines data sharing, replacing manual record transmission with a secure, centralized network that supports real-time updates and reduces third-party fees.
By simplifying payer-provider interactions, Oracle Health’s AI suite fosters faster, more accurate transactions and better patient care. The solutions are designed for scalability, integrating seamlessly with existing EHR systems and supporting providers and payers globally in optimizing resources and care quality.
Oracle offers integrated suites of applications plus secure, autonomous infrastructure in the Oracle Cloud. For more information about Oracle (NYSE: ORCL), please visit us at www.oracle.com.
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