Oracle Health Insurance Claims Adjudication and Pricing (4.26.1)

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

Configuration Guide

    • Application Overview
    • Benefit Rules
      • Adjudication Limits
      • Coverage Regimes
      • Reservation Regimes
      • Authorization Regimes
      • Waiting Period Regimes
      • Reinsurance Regimes
      • Regime Counters
      • Case Definitions
      • Integration Points
    • Process Rules
      • Claim Callout Rules
      • Claim Callout Integration Point
      • Claim Event Rules
      • Claim Event Integration Point HTTP
      • Pend Reasons
      • HTTP Pend Resolution Integration Point
      • Workflow Integration Point HTTP
      • Combination Checks
      • Derivation Rules
      • Dynamic Checks
    • Claims Configuration
      • Claim Forms and Claim Form Types
      • Diagnosis Types
      • Location Types
      • Modifiers
      • Pend Reasons
      • Settlement Reasons
      • Specialties
      • Unfinalize Reasons
      • Integration Points
    • Pricing Configuration
      • Reimbursement methods
        • Bundled Amounts
        • Charge Amounts
        • Diminishing Rates
        • Fee Schedules
        • Payment Functions
      • Components Model
      • Provider Limit Counters Model
      • Provider Pricing Clauses Model
      • Claims Classification Model
      • Episode Model
      • Pricing Templates
      • Draft Provider Pricing Clauses Worksheet
      • Pricing Worksheets
      • Draft Provider Pricing
    • Eligibility Checks
      • Eligibility Checks
      • Eligibility Validation Rules
      • Eligibility Callout Rules
      • Eligibility Response Definition
      • Example Scenario
    • Extensibility
      • Claims Configuration Extensibility
        • Field Definition
        • Flex Code Definitions
        • Record Definitions
        • Extending Tables
        • Flex Code Group
        • Flex Code Set
        • Flex Code specifying Procedures, Diagnosis and Providers
      • Transactions Extensibility
        • Field Definitions
        • Record Definitions
        • Extending Tables
    • End User Macros
      • Macro Definition
    • Reference Data
      • Relations
      • Providers
      • Providers Integration Point
      • Diagnosis
      • Diagnosis Integration Point
      • Procedures
      • Procedure Integration Point
      • Payers and Brands
      • Benefit Specifications
      • Products and Product Benefit Specifications
      • Product Building Blocks Integration Point
      • Insurance Types and Insurable Entities
      • Insurable Object Integration Point
      • Product Benefit Specification Integration Point
      • Foundation
        • Messages
        • Boilerplate Text
        • Transaction Sources
      • Money
        • Money Library
    • Configuration Migration
      • Introduction
      • Creating a Migration Set
      • Building a Configuration Migration Set
      • Loading a Migration Set
      • Migration Behavior
      • Source Environment Tracking
      • Change Tracking
Configuration Guide
  • Administration Guide
  • All Guides
  • Configuration Guide
  • Developer Guide
  • Installation Guide
  • Licensing Information User Manual
  • Operations Guide
  • Security Guide
  • Configuration Guide
  • Benefit Rules
  • Integration Points

Integration Points

For more information on Integration Points, see the following topics:

  • Adjudication Counters Integration Point

Case Definitions Claim Callout Rules

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