Financial Transaction Model

This section describes the entity model that covers the financial elements of the Claims process.

Reversal Financial Transactions

Reversal financial transactions are transactions with most amounts and numbers reversed (multiplied by -1). The Reverse? column in the table below indicates if a value is to be reversed in reversal transactions. Refer to Reversal Transactions section for more details.

Base Financial Object

Base financial objects represent 'what' financial transactions are for (in most cases, what is being 'paid for'). Each of these objects has an initial financial transaction (that is created together with the base object when it first becomes ready for Oracle Health Insurance financial processing) and may have additional financial transactions - additional versions - resulting from reprocessing of the base object that impacts financial aspects of it.

Field	Reverse?	Description
Claim Code		The code of the Claim
Gen Fin Proc Complete Datetime		Date and time on which the general financial processing activities have been completed for the base financial object
Status		Status of the base financial object. Possible values: IN - Initial CH - Changed SR - Supersede and Reverse Done FM - Financial Message Handled
Type		The type of the base financial object indicating the origin, which is always 'CLA' for Claims
Claim Set Code		The code of the claim set to which the claim is assigned

Financial Transaction

This entity holds the financial transactions generated by the finalization of Claims processing. Claims processing creates one financial transaction for each claim transaction, also known as a version of the claim.

Field	Reverse?	Description
Base Financial Object		Reference to the base financial object
Final Indicator		Indicates whether the financial transaction may be included in a financial message. For Claims this indicator is always set to Yes.
Processing Type		The type of transaction indicating the way it is processed. For Claims this type is always set to RG - Regular.
Reversal Indicator		Indicates whether this financial transaction is meant to reverse a previous financial transaction.
Source		Reference to the origin of the financial transaction. For Claims this origin is always CP (Claims Processing).
Total Amount	Y	The sum of the amounts of the financial transaction details in this financial transaction.
Total Amount Curr		The currency code of the total amount.
Version		Version number of the financial transaction within a base financial object.

Financial Transaction Process Data

Financial transaction process data records hold information that is added to financial transactions for financial processing purposes. The purpose of these details is provide a specific place for information added / updated for processing purposes in order to maintain the integrity of the financial transaction as received from the source system.

Field	Reverse?	Description
Financial Transaction Set Grouping		The condition used to group financial transactions into a single financial transaction set. By default this is not set.
Fin Message Bulking Group		The condition used to group financial transactions into a single financial message
Fin Message ID		The identification of the financial message this financial transaction is included in.
Financial Message Handled Datetime		The date and time the financial transaction was handled by the financial message creation activity
Financial Message Mandatory Indicator		Is a financial message mandatory for this financial transaction?
Financial Message Result		The outcome of message creation: message created or message not required M - Message created N - Not required S - Superseded
Financial Transaction		Association to the financial transaction
Internal Remarks		Additional remarks on the financial transaction
Penalty Date		The penalty date
Due Date		The penalty date of this financial transaction
Superseded Indicator		Is the financial transaction superseded?

Financial Transaction Detail

This entity holds the financial transaction details generated by the finalization of Claims processing. Claims processing by default creates one financial transaction detail for each claim line transaction coverage; this can be enhanced through dynamic logic.

Financial transaction details represent the lowest level financial breakdown of a financial transaction. Each financial transaction detail is an amount with information needed for its financial processing.

Financial transaction details are not updated in line with general accounting principles. Processing related information for a financial transaction detail is maintained in a corresponding 'Financial Transaction Detail Process Data' record.

Field	Reverse?	Description
Amount	Y	The amount of the financial transaction detail
Amount Curr		The currency code of the amount
Claim Line Code		The code of the claim line, unique within a claim
Component Code		The code of the component, default the coverage label
Component Display Sequence		The sequence of the component for display purposes
Financial Transaction		Association to the financial transaction
Number of Units	Y	The number of units
Product Brand Code		The code of the brand of the product
Product Code		The code of the product
Sequence Number		The unique identifier of the financial transaction detail within the financial transaction (generated sequence within parent)

Financial Transaction Detail Process Data

Financial transaction detail process data records hold information that is added to financial transaction details for financial processing purposes. The purpose of these details is provide a specific place for information added / updated for processing purposes in order to maintain the integrity of the financial transaction as received from the source system.

Field	Reverse?	Description
Accounting Bulking Group		Grouping condition for accounting detail creation
Accounting Detail Grouping Indicator		Are financial transaction details grouped into accounting details?
Accounting Detail ID		Oracle Health Insurance generated unique accounting detail identifier that covers the financial transaction detail
Financial Transaction Detail		Association to the financial transaction detail
General Ledger Account		The general ledger account where the amount of this transaction detail should be booked
Internal Remarks		Additional remarks on the financial transaction detail
Invoice Bulking Group		Grouping condition for invoice creation
Invoice ID		Oracle Health Insurance generated unique invoice identifier
Invoice Indicator		Should this transaction detail be invoiced?
Invoice Line Bulking Group		Grouping condition for invoice line creation
Invoice Line Grouping Indicator		Are financial transaction details grouped into invoice lines?
Invoice Line ID		Oracle Health Insurance generated unique invoice line identifier
Pay from Bank Account		The bank account to pay this financial transaction detail from.
Payment Ben Flex Code Value		The flex code value for the payment beneficiary
Payment Beneficiary Code		The code of the payment beneficiary
Counterparty Qualifier		The flex code value for the payment receiver
Counterparty Code		The code of the payment receiver