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:
|
|
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. |
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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. |
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Fin Message Bulking Group |
The condition used to group financial transactions into a single financial message |
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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
|
|
Financial Transaction |
Association to the financial transaction |
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Internal Remarks |
Additional remarks on the financial transaction |
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Penalty Date |
The penalty date |
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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 |
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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 |
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Invoice ID |
Oracle Health Insurance generated unique invoice identifier |
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Invoice Indicator |
Should this transaction detail be invoiced? |
|
Invoice Line Bulking Group |
Grouping condition for invoice line creation |
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Invoice Line Grouping Indicator |
Are financial transaction details grouped into invoice lines? |
|
Invoice Line ID |
Oracle Health Insurance generated unique invoice line identifier |
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Pay from Bank Account |
The bank account to pay this financial transaction detail from. |
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Payment Ben Flex Code Value |
The flex code value for the payment beneficiary |
|
Payment Beneficiary Code |
The code of the payment beneficiary |
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Counterparty Qualifier |
The flex code value for the payment receiver |
|
Counterparty Code |
The code of the payment receiver |