Claim’s Application Specific Custom Properties

The Oracle Health Insurance JET framework provides a set of custom properties which can be used with pre-defined resources to display JET specific fields like formatted name, recent group account holders etc. Some of these custom properties are same across applications and some are application specific.

These custom properties are defined below:

Properties

Coverage Regimes (CL0005)

  1. Custom Property: typeTrancheJET

    • Resource: coverageregimeperiodtranches

    • Description:

      • This property displays as a List Of Values

        1. Currency

          • Type on ‘Tranches’ for coverage regime on view and edit detailed screen, the currency is derived from the currency selected on coverage regime.

        2. Days

        3. #

  2. Custom Property: maximumInsurableEntityJET

    • Resource: coverageregimeperiodtranches

    • Description:

      • This is a single property to update and display values (to and from) respectively based on the type selected in 'typeTrancheJET' property.

        1. maximumNumberInsurableEntity,

        2. maximumServiceDaysInsurableEntity and

        3. maximumAmountInsurableEntity

  3. Custom Property: maximumFamilyJET

    • Resource: coverageregimeperiodtranches

    • Description:

      • This is a single property to update and display values (to and from) respectively based on the type selected in 'typeTrancheJET' property.

        1. maximumNumberFamily,

        2. maximumServiceDaysFamily and

        3. maximumAmountFamily

  4. Custom Property: typeLimitJET

    • Resource: counttowardslimits

    • Description:

      • Based on the limit selected, this property respectively displays

        1. Currency

          • The currency is derived from the coverage regime.

        2. Days

        3. #

  5. Custom Property: maximumJET

    • Resource: counttowardslimits

    • Description:

      • This is a single property to update and display values (to and from) respectively based on the type selected in 'typeLimitJET' property.

        1. maximumNumber,

        2. maximumServiceDays and

        3. maximumAmount

  6. Custom Property: amountPerUnitJET

    • Resource: coverwithholdrules

    • Description:

      • This is a Custom money field property to display read only currency code which is derived from coverage regime.

Authorization Regimes (CL0006)

  1. Custom Property: authRegimeTypeTrancheJET

    • Resource: authorizationregimeperiodtranches

    • Description:

      • This property displays as a List Of Values

        1. Currency

          • The currency is derived from the currency selected on authorization regime.

        2. Days

        3. #

  2. Custom Property: authRegimeMaximumJET

    • Resource: authorizationregimeperiodtranches

    • Description:

      • This is a single property to update and display values (to and from) respectively based on the type selected in 'authRegimeTypeTrancheJET' property.

        1. maximumAmount,

        2. maximumServiceDays and

        3. maximumNumber

Benefit Specifications (CL0008)

  1. Custom Property: regimeJET

    • Resource: benefitspecifications

    • Description:

      • This property is used to display the respective subtype of regime that is selected for a benefit specification.

        • Example: If the subType is AUTH, authorizationRegime code and description is shown

Authorization (CL0022)

  1. Custom Property: basketProcedureJET

    • Resource: authorizationconsumptions

    • Description:

      • This propertyis used to fetch data from authorization counter and display procedure code

  2. Custom Property: allowedNumberOfUnitsJET

    • Resource: authorizationconsumptions

    • Description:

      • This property is mapped to 'allowed number of units' or 'claimed number of units' data on claimLine

  3. Custom Property: consumedServiceDaysJET

    • Resource: authorizationconsumptions

    • Description:

      • This property displays empty or 1 value, depending on authorization counter (auth line and auth baskets ).

  4. Custom Property: basketCodeJET

    • Resource: authorizationconsumptions

    • Description:

      • This property is used to fetch data from authorization counter and display basket code.

  5. Custom Property: authorizationLineCodeJET

    • Resource: authorizationconsumptions

    • Description:

      • This property is used to fetch data from authorization counter and display authorization line code.

  6. Custom Property: consumptionOnJET

    • Resource: authorizationconsumptions

    • Description:

      • This property is used to display text (Line, basket,authorization)based on authorization counter.

Provoder Limit Categories and Rules

  1. Custom Property: providerLimitValueJET

    • Resource: providerlimitheights

    • Description:

      • Based on Provider limit category 'Type' value, the 'providerLimitValueJET' is displayed as

        1. Currency

        2. Days

        3. #

Provider Pricing Clause (CL0087)

  1. Custom Property: sizeJET

    • Resource: diminishingrateblocks

    • Description:

      • This is a read only property to display the size value from the diminishing rate code that is selected on PPC.

  2. Custom Property: rateJET

    • Resource: diminishingrateblocks

    • Description:

      • This is a read only property to display the rate value from the diminishing rate that is selected on PPC.

  3. Custom Property: overrideSizeJET

    • Resource: diminishingrateblocks

    • Description:

      • This property is used to Override the size value for the respective provider pricing clause without impacting to values on original diminishing rates.

  4. Custom Property: overrideRateJET

    • Resource: diminishingrateblocks

    • Description:

      • This property is used to Override the rate value for the respective provider pricing clause without impacting to values on original diminishing rates.

  5. Custom Property: ppcReimbursementMethodRuleJET

    • Resource: providerpricingclause

    • Description:

      • This is a property shown as a dropdown with combination of reimbursement method subtypes and pricing rule subtypes.

  6. Custom Property: ppcReimbursementMethodJET

    • Resource: providerpricingclause

    • Description:

      • This property shows the appropriate reimbursement method or pricing rule subtypes as a List Of Values, based on the selection of 'ppcReimbursementMethodRuleJET' property.

  7. Custom Property: ppcQuantifierJET

    • Resource: providerpricingclause

    • Description:

      • This is a property with two input boxes,

        1. One specifying the type of the quantifier (%/#/Currency Dropdown) and

        2. The other specifying the value for the respective quantifier.

Pricing Option (CL0104)

  1. Custom Property: reimbursementMethodRuleJET

    • Resource: providerpricingclause

    • Description:

      • This is a property shown as a dropdown with combination of reimbursement method subtypes and pricing rule subtypes.

  2. Custom Property: reimbursementMethodJET

    • Resource: providerpricingclause

    • Description:

      • This property shows the appropriate reimbursement method or pricing rule subtypes as a List Of Values, based on the selection of 'reimbursementMethodRuleJET' property.

  3. Custom Property: quantifierJET

    • Resource: providerpricingclause

    • Description:

      • This is a property with two input boxes,

        1. One specifying the type of the quantifier (%/#/Currency Dropdown) and

        2. The other specifying the value for the respective quantifier.

Diminishing Rates (CL0109)

  1. Custom Property: blockRangeJET

    • Resource: diminishingrateblocks

    • Description:

      • This property is used to display range based on Block Size (Ex: BlockSize 100, 0 - 100)

  2. Custom Property: rateJet

    • Resource: diminishingrateblocks

    • Description:

      • This property is used to display Number field with currency

Episodes (CL0145)

  1. Custom Property: totalAllowedJET

    • Resource: episodes

    • Description:

      • This property shows the sum of the allowed amount of all the claim lines of the episodeDetails of an episode.

  2. Custom Property: totalChargedJET

    • Resource: episodes

    • Description:

      • This property shows the sum of the claimed amount of all the claim lines of the episodeDetails of an episode.

  3. Custom Property: reimbursementMethodEpisodeJET

    • Resource: episodesdetails

    • Description:

      • This property displays the reimbursement method in one and only provider pricing clause among the list of provider pricing clauses under episodes.

Draft Provider Pricing Clause (CL0098)

  1. Custom Property: lastBuildByJET

    • Resource: pricingworksheets

    • Description: This property is used to display the user name by referring to the id of 'lastBuildBy'

  2. Custom Property: lastValidatedBYJET

    • Resource: pricingworksheets

    • Description: This property is used to display the user name by referring to the id of 'lastValidatedBy'

  3. Custom Property: validationStatusJET

    • Resource: draftproviderpricingclauses

    • Description: This property has a hyperlink and when clicked displays message in case validation status is invalid.

  4. Custom Property: buildStatusJET

    • Resource: draftproviderpricingclauses

    • Description: This property has a hyperlink and when clicked opens the pricing provider clause that is built from that DPPC.

  5. Custom Property: dppcMethodRuleTypeJET

    • Resource: draftproviderpricingclauses

    • Description: This property is used to display the types of reimbursement methods and pricing rules in one drop down.

  6. Custom Property: dppcMethodRuleJET

    • Resource: draftproviderpricingclauses

    • Description: This property fetches the values for the Method or Rule based on the selection in the 'dppcMethodRuleTypeJET' property.

  7. Custom Property: individualProvidersDefJET

    • Resource: draftproviderpricingclauses

    • Description: This property give the ability to search the individual provider in context with the individual provider definition. Once selected the code and definition are stored in the respective standard properties.

  8. Custom Property: organizationalProvidersDefJET

    • Resource: draftproviderpricingclauses

    • Description: This property give the ability to search the organizational provider in context with the organizational provider definition. Once selected the code and definition are stored in the respective standard properties.

  9. Custom Property: dppcQuantifierJET

    • Resource: draftproviderpricingclauses

    • Description: This property values are displayed based value selected on the property 'dppcMethodRuleJET'.

  10. Custom Property: dppcRestrictToMethodJET

    • Resource: draftproviderpricingclauses

    • Description: This property is used to display the methods that could be restricted on DPPC.

  11. Custom Property: dppcOverrideRateJET

    • Resource: draftproviderpricingclauses

    • Description: This property is used to display diminishing rates and allow user to override the diminishing rates on DPPC when the menthod is selected as diminishing rates.

  12. Custom Property: dppcOverrideSizeJET

    • Resource: draftproviderpricingclauses

    • Description: This property is used to display diminishing rates and allow user to override the diminishing rates sizes on DPPC when the menthod is selected as diminishing rates.

  13. Custom Property: dppcLastUpdatedByJET

    • Resource: interfacedmessages

    • Description: This property is used to display the user name by referring to the id of 'lastUpdatedBy'

Adjudication Cases (CL0055)

  1. Custom Property: finalJET

    • Resource: adjudicationcasedetail

    • Description: This property is used to display if the linked claim is in status final for not. This shows 'yes' if claim is in status final and 'left blank' is claim is not in status final.