Creating a Migration Set

Migration sets are assembled through a dedicated user interface page. This page allows the user to select the top level migration items that should be included in the set, and provides options on which dependent items to exclude.

The page is divided into two sections. The upper region shows the created configuration sets. Per set, the user has the option to include certain types of linked reference data. These options apply across the entire migration set, e.g., if the user opts to include providers, then all providers that are linked to one or more items in the data set are included.

Including Reference Data

The reference data inclusion option is restricted to records that are linked to the migrated configuration payload. For example, if the source environment has 1000 providers, but only 600 of them are linked to the configuration in the payload, then only the 600 linked providers are migrated.

Reference Data	Automatically Includes
diagnoses	access restriction diagnosis setting
procedures	access restriction procedure setting
payers	access restriction (payer and brand) brand payer code
providers	individual provider: bank account number bank account validation country country region dynamic logic (bank account validation and name format) prefix provider (service address organization provider) provider specialty provider title rendering address service address specialty title provider identifier organization provider: bank account number bank account validation country country region dynamic logic (bank account validation) provider (parent organization provider) provider specialty provider identifier service address specialty

If a migration set includes linked reference data, it also automatically includes any setup configuration that is required; there is no option to exclude the supporting configuration. For example, if a provider has a specialty (top level item) that has not been explicitly added to the migration set, then the configuration migration function will still add the specialty (to ensure a successful migration for that provider).

Including Configuration Items

The bottom region on the page shows which configuration items are available for migration. This area allows a user to quickly include all records for a particular top level item or even all records for all top level items, i.e., a full configuration migration, through selection check boxes. Alternatively, a user can add or remove individual records of specific items to and from the set by clicking on the pencil icon. The icon opens a dialog for that specific item that allows the user to browse, select and deselect the available items on the environment.

Per top level configuration item, the user has the option to exclude specific dependent items. For example, the user has the option to migrate provider pricing clauses with or without the dependent fee schedules. Migrating with the fee schedules means that the fee schedules are also part of the migration payload; without means all references to fee schedules are migrated, but the fee schedule itself is not included in the payload. For this option to work, the fee schedule must be present on the target environment prior to the migration.

The intended user for this page is the configuration expert, i.e., the same user that has made the configuration changes. This is the person who knows which changes are ready for migration, and which are not. It is important to note that creating and saving a migration set in this page does not make the migration set available for other environments to import; this is a separate step controlled through another page and most likely another user.

Below is the comprehensive list of configuration items that can be included, per individual record, in a configuration migration data set. Each entry mentions which dependent items are auto-included and which dependent items can be excluded as an option.

Top Level Item	Automatically Includes	Optional Excludes
access role	access restriction access restriction grant claim access restriction claim access restriction form currency data access group	claim form
activity type	dynamic field usage(1) flex code system parameter set parameter set dynamic line	-
address type	-	-
advice response definition	-	dynamic logic
authorization form	-	-
authorization regime	authorization regime period authorization regime period tranches coverage label currency	dynamic logic message
basket	basket detail currency	-
benefit specification	benefit priority benefit specification dynamic logic benefit specification location type benefit specification modifier benefit specification provider group benefit specification specialty claim form type diagnosis type	authorization regime case definition country region country region group coverage regime(2) diagnosis group dynamic logic limit (displayed as adjudication limit in the UI) location type message modifier post benefits regime procedure group provider group reservation regime specialty waiting period regime
boilerplate text	-	-
bundled amount	bundled amount category episode category episode definition reimbursement method type	message
callout definition (displayed as claim callout rule in the UI)	claim callout rule skip tag skip tag claim form	classification scheme dynamic logic
case definition	ancillary inclusion rule	diagnosis group dynamic logic message procedure group
charged amount	charged amount classification charged amount modifier reimbursement method type classification	dynamic logic message modifier procedure group
claim event rule	claim event rule form	claim form dynamic logic message group procedure group
claim form	claim form type line of business	flex code system
claim transaction event rule	-	dynamic logic
classification scheme	brand classification classification scheme detail classification scheme detail modifier classification scheme form classification priority funding arrangement product category product category dimension product category dynamic logic product family product line provider category provider category dynamic logic provider category specialty	claim form diagnosis group dynamic logic location type group message modifier procedure group product provider group specialty
combination check	combination check claim form combination check procedure	claim form dynamic logic message procedure group
contract reference	-	-
country	bank account validation	dynamic logic
country region	country	-
country region group	country region group detail	country region
coverage regime	count towards limit cover withhold rule cover withhold category coverage label coverage regime period coverage regime period tranche currency	limit (displayed as adjudication limit in the UI) message
currency	-	-
derivation rule	derivation rule form	claim form dynamic logic
diagnosis group	diagnosis group detail	-
diagnosis type	-	-
diminishing rate	currency diminishing rate block diminishing rate block amount(3) diminishing rate block size(3) reimbursement method type	message
dynamic check	dynamic check claim form	claim form dynamic logic message product
dynamic field usage (displayed as usage in the UI)	dynamic logic field flex code system message	-
dynamic logic	dynamic logic reference sheet message	reference sheet
eligibility response definition	callout rule process step rule step validation rule	dynamic logic message
episode definition	episode category episode criteria payer	diagnosis group dynamic logic message procedure group
exchange rate	currency	-
external intervention rule	brand external intervention rule form	claim form diagnosis group dynamic logic message group pend reason procedure group unfinalize reason group
fee schedule	classification currency fee schedule line fee schedule line classification fee schedule line modifier fee schedule modifier reimbursement method type	contract reference dynamic logic message modifier procedure group provider group
fee schedule line(4)	classification currency fee schedule fee schedule line classification fee schedule line modifier fee schedule modifier reimbursement method type	contract reference dynamic logic message modifier procedure group provider group
financial hold type	-	-
flex code group	flex code group detail	flex code system
flex code system	dynamic logic field flex code flex code field usage flex code set detail flex code system message
floorplan	floorplan tag details
gender identity	-	-
geographic region	geographic condition	dynamic logic
HTTP link	-	dynamic logic
identifiers type	access restriction
insurable entity type	-	-
limit (displayed as adjudication limit in the UI)	limit sub limit(10)	dynamic logic message
line of business	insurable entity type line of business insurable entity type	-
location type	claim form type	-
location type group	location type group detail	location type
message	-	-
message creation scenario	-	dynamic logic
message group	access restriction message group detail	message
modifier	-	-
payment function	reimbursement method type	dynamic logic message
pend reason	access restriction	dynamic logic
post benefits regime	cover withhold category coverage label post cover withhold rule	dynamic logic message
prefix	-	-
pricing option	-	-
pricing template	pricing section pricing section option	pricing option
procedure group	procedure group detail	-
process field derivation rule	process field derivation rule form process field derivation priority	claim form dynamic logic location type group procedure group
product	brand cover withhold category currency funding arrangement product benefit specification product benefit specification limit product benefit specification reinsurance product benefit specification value product family product limit product line product priority product provider group	authorization regime benefit specification(5) case definition country region country region group coverage regime diagnosis group dynamic logic limit (displayed as adjudication limit in the UI) location type message modifier post benefits regime procedure group provider group reservation regime specialty waiting period regime
provider assignment type	-	-
provider group	provider group affiliation	-
provider pricing clause(6)	adjustment execution phase adjustment percentage brand classification currency diminishing rate block amount(7) diminishing rate block size(7) funding arrangement pricing external intervention rule form pricing priority pricing rule pricing rule classification pricing rule modifiers pricing rule reimbursement method type product category product category dimension product category dynamic logic product family product line provider category provider category dynamic logic provider category specialty provider limit category provider limit height provider pricing clause claim classification provider pricing clause claim line classification provider pricing clause classification scheme provider pricing clause dynamic logic provider pricing clause restrict reimbursement method reference sheet reference sheet line(8) skip tag skip tag claim form	bundled amount charged amount claim form classification scheme contract reference diagnosis group diminishing rate dynamic logic fee schedule location type group message message group modifier payment function pend reason procedure groups product provider group specialty unfinalize reason group
reference sheet	dynamic field usage(9) reference sheet line(8)	-
reservation regime	coverage label	dynamic logic message
service type	-	-
settlement reason	access restriction	-
specialty	-	-
tag type	tag type message	message
title	-	-
transaction scenario	-	dynamic logic
transaction source	transaction source usage	-
unfinalize reason	-	-
unfinalize reason group	unfinalize reason group detail	unfinalize reason
waiting period regime	-	dynamic logic message

⁽¹⁾ An activity type can rely on a single dynamic field usage record that serves as an integral part of the activity type by connecting the parameter sets of the activity type to their definition. This dynamic field usage record is not visible in any user interface page, but is migrated as part of the activity type.

⁽²⁾ Excluding coverage regimes will automatically exclude limits.

⁽³⁾ Diminishing rate block amounts and sizes that are linked to a provider pricing clause are not included as dependent items of the diminishing rate. These are dependent items of the provider pricing clause.

⁽⁴⁾ There is no checkbox (for adding/removing all items) available for top level item Fee Schedule Line. This top level item is meant for selective migration of fee schedule lines; migrating all fee schedule lines can be done by selecting all fee schedules.

⁽⁵⁾ Excluding benefit specifications will automatically exclude the other optional excludes that belong to benefit specifications.

⁽⁶⁾ Provider pricing clauses can be created by using drafts. Each clause is linked to the draft from which it is generated. Since the draft clauses are not within the scope of the migration function, the reference to the original draft is not migrated. In addition to the reference, the clause also stores information that identifies the draft clause in two character fields; these fields are migrated.

⁽⁷⁾ Diminishing rate block amounts and sizes that are linked to a provider pricing clause are always included as dependent items of the provider pricing clause, even when the provider pricing clause is migrated without the diminishing rate.

⁽⁸⁾ Reference sheet lines that are linked to a provider pricing clause and draft provider pricing clause are not included as dependent items of the reference sheet. The reference sheet lines linked to a provider pricing clause are dependent items of that provider pricing clause.

⁽⁹⁾ Each reference sheet relies on a single dynamic field usage record that serves as an integral part of the reference sheet by connecting the reference sheet to its definition. This dynamic field usage record is not visible in any user interface page, but is migrated as part of the reference sheet.

⁽¹⁰⁾ The limits referenced by the sub limit are also included

Optional Excludes

Configuration rules in OHI Claims Adjudication are hierarchical in nature; complex configuration rules are a composite of more basic configuration rules. For example, a provider pricing clause is a composite of fee schedule, provider group and procedure group (and more). In turn, the fee schedule is a composite of dynamic logic, messages and procedure groups (and more) as well.

To assist the user in assembling a migration payload, the migration function automatically determines what other configuration is required to successfully install the selected configuration item on the target environment. The exclude options allow the user to carve out configuration records from that automatic inclusion. Consider the following example to clarify.

Provider pricing clause A refers to fee schedule B. In this context, fee schedule B is a dependent item to the provider pricing clause A; if provider pricing clause A is selected for migration, the user has the option to include all referenced fee schedules as part of that migration as well, including fee schedule B.

Because a fee schedule is also a top level item, the user can alternatively choose to migrate provider pricing clause A without migrating fee schedule B as well. This alternate approach requires that fee schedule B is already present on the target environment. This allows the user to have separate configuration tracks, e.g., the updates to the provider pricing clauses using fee schedule B can be migrated before migrating the updates to fee schedule itself.

Dynamic Field and Record Usages

Configuration items can be extended with dynamic fields and records. If an extended item is included in the payload, the dynamic field and record values and the related dynamic field usages are automatically included as well. The target environment requires the dynamic field usages in order to know where it can find and update the dynamic field values.