Financial Transactions
Financial transactions hold financial information resulting from the claims adjudication, intended to be forwarded to the downstream financial system for payment or invoicing.
As part of the Finalize Claim step in the claims flow the system creates financial transactions. Every time the system finalizes a claim, it creates a new set of financial transactions for the claim. Financial transactions for old claims versions are reverted or superseded. The system does not remove financial transactions from previous versions of the claim.
Base Financial Object
In Oracle Health Insurance the Base Financial Object refers to the financial information of a claim that is not specific for a certain version of that claim.
The Base Financial Object holds, beside the claim code the following information:
- Status
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What is the status of of the financial results in the process of sending the transactions to the downstream financial system.
- Processing Complete
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The timestamp when the transactions where sent to the downstream financial system
Financial Transactions
A financial transaction holds the financial calculation results of processing (one version of) a claim.
Oracle Health Insurance does not delete financial transactions of older claims versions. Always take the correct version of the transaction into consideration when retrieving financial transactions for a claim.
Financial transactions can be extended with dynamic fields and dynamic records [1]. This enables passing through customer specific information from the claim or claim process into the financial transaction and from there to the downstream financial system.
Financial Transactions hold information on
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Calculation, for example the total amounts of the financial transaction details
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Financial processing, for example is the transaction superseded/[2], the due date and the penalty date of the transaction
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Invoicing, for example the way transactions are grouped in financial messages
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Tracking, for example the financial message id and when was the financial message created. The Generate Financial Message activity stamps this information on the financial transaction details as part of that activity.
Financial Transaction Details
A financial transaction detail holds the the calculated amount and other calculation information on claim line level and coverage level.
Financial transaction details can be extended with dynamic fields and dynamic records [3].
Financial transaction details hold information on
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Payments, for example From Bank Account_[4], _Receiver, and Beneficiary.
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Invoicing, for example the way transactions are grouped in invoices and invoice lines
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Accounting, for example the way transactions are grouped in accounting details
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Tracking, for example the specific invoice, invoice line and accounting detail the transaction detail is placed. The Generate Financial Message activity stamps this information on the financial transaction details as part of that activity.
Updating the mandatory indicator sets the status of the claim’s base financial object to Changed. This means that the Supersede financial transactions activity must executed (again) for the claim’s base financial object before a financial transaction for this claim can be included in a financial message.
Holds
A financial transaction detail is on hold when:
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The financial transaction is not handled by the Generate Financial Message process and a financial hold exists on one of the related hold entities that is not expired or released.
The related hold entities are claim (transaction), product and provider. When a financial hold applies to a certain claim version, all claim versions with a higher version number are on hold as well.