Oracle Health Insurance Claims Adjudication and Pricing (4.25.1)

Operations Guide
Administration Guide All Guides Configuration Guide Developer Guide Installation Guide Licensing Information User Manual Operations Guide Security Guide

Operations Guide

    • Overview
      • Introduction
      • Key Features
      • Adjudication Workflow
    • Authorizations
      • Authorizations
      • Authorization Integration Point
    • Claims
      • Data Model
        • Claims
        • External Claims Data
        • Repository Model
      • Claims Pages
        • Search Claims
        • Create Claim
        • View and Edit Claim
        • Manual Pricing
        • Manual Pricing Adjudication
        • Manual Benefits
        • Manual Adjudication of a Claim
    • Claims Flow
      • Flow Overview
      • Large Claims Flow
      • Receive Change or Enter Claim
      • Integration Points
      • Sanity Checks
      • Pre-Pricing Checks
      • Enrollment Callout
        • Gathering Enrollment Data
        • Enrollment Integration Point
        • Scenarios
      • Reservation Selection, Claim Classification, and Episode Detection
      • Pricing
        • Introduction
        • Key Features
        • Pricing Overview
        • Pricing Workflow
        • Clean Up Pricing Results
        • Select and Apply Reimbursement
          • Select and Apply Reimbursement Method and Pricing Rules
          • Fee Schedule Line Dynamic Priority
          • Select and Apply Provider Limit Rules
          • Select Provider Pricing Clauses
          • Track Provider Pricing Clauses
        • Examples
          • Adjustment Rules
          • Diminishing Rates
          • Bundled Amounts
          • Provider Limit Rules
          • Inclusion Rules
          • Price Principal Procedures
          • Replacement Rules
      • Pricing Adjudication
      • Pricing Finalization
      • Payment Status Callout
        • Gathering Payment Status Data
        • Payment Status Integration Point
      • Pre Benefit Checks
      • Benefits
        • Benefits
        • Clean Up Benefits Results
        • Select Policy Products
        • Select Benefit Specifications
        • Select Benefit Specifications for Ancillary Lines
        • Validate Selection
        • Evaluate Regimes
        • External Intervention
      • Benefits Adjudication
      • Finalization
        • Finalize Claim
        • Unfinalize Claim
      • Appendices
        • Case Recognition Scenario
        • Scenario 1 - Externalized Benefit Selection
        • Portable Waiting Periods
        • Consumption
        • Case Definitions
        • Routing Slips
        • Claim Line Locking Scenarios
    • Financial Preprocessing
      • Financial Preprocessing Overview
      • Financial holds
      • Financial Preprocessing – Select Transactions into a Set
      • Financial Preprocessing – Supersede
      • Generate Financial Message
      • Resend Financial Message
      • Unsend Financial Message
      • Dynamic Logic Functions
      • Create Accounting Details from Registrations
      • Generate Accounting Detail Message
      • Scenarios
        • Claim with 2 Adjustments
        • Initially Denied Claim
        • Subsequently Denied Claim
        • Subsequently All Withhold Claim
        • Non-Invoiced Claim with Adjustment
        • Mixed Claim
        • Multiple Payment Receivers with Adjustment
        • Financial Message Mandatory
    • Operational Reporting
      • Overview
        • Data Model
        • Reporting View Metadata
          • Claims In Progress
          • Task Processing Performance
      • Installation
      • Integration Points
      • User Interface
        • Report Page
        • Operational Reports
      • User Access
Operations Guide
  • Administration Guide
  • All Guides
  • Configuration Guide
  • Developer Guide
  • Installation Guide
  • Licensing Information User Manual
  • Operations Guide
  • Security Guide
  • Operations Guide
  • Operational Reporting
  • User Interface

User Interface

This page lists the topics needed to build a JET user interface for an operational review that is generated using the Operational Reporting View integration point.

Reporting View Metadata

  • Claims In Progress

  • Task Processing Performance

Floor Plan

For detailed instructions on configuring a floor plan for a Reporting View, see Report Page.

Data Transfer From JET User Interface

For information on data transfer, see Operational Reports.

Integration Points Report Page

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