Release Notes for Oracle Health Insurance Claims Adjudication Patch 3.21.1.0.1

This document contains the release notes for Oracle Health Insurance Claims Adjudication Patch 3.21.1.0.1.

Version compatibility: Oracle Health Insurance Claims Adjudication Release 3.21.1.x is only compatible with other Oracle Health Insurance applications release version 3.21.1.x unless explicitly stated otherwise.

Enhancements

ID	Summary	Description	Included in Patch
NXT-20626	Claims processing should provide notification callback possibility	Claim processing is a long running async process that is not backed up by a notification callback. The only way to know that the process is finished successfully or not, is to poll for its status. It would be beneficial to provide a notification capability at the end of the process whether ending in success or in failure. This also has to cater for the situation that a claim halts with a technical error. Solution Successful task completion can be notified to the external system by using claim event rules. However, claim event rules can not be used to monitor technical error(s). Therefor the claims flow is extended with the option to send a notification to an endpoint when the flow has raised a technical error. The endpoint defintion is stored as a system property. If the system property is not defined or of it has no value the flow will not send a notification. If it has a value, it will send the notification to this endpoint. The system property is: ohi.CLAIM_FLOW_ERROR.endpoint.request

Summary

Description

Included in Patch

NXT-20626

Claims processing should provide notification callback possibility

Claim processing is a long running async process that is not backed up by a notification callback. The only way to know that the process is finished successfully or not, is to poll for its status. It would be beneficial to provide a notification capability at the end of the process whether ending in success or in failure. This also has to cater for the situation that a claim halts with a technical error.

Solution Successful task completion can be notified to the external system by using claim event rules. However, claim event rules can not be used to monitor technical error(s). Therefor the claims flow is extended with the option to send a notification to an endpoint when the flow has raised a technical error. The endpoint defintion is stored as a system property. If the system property is not defined or of it has no value the flow will not send a notification. If it has a value, it will send the notification to this endpoint. The system property is: ohi.CLAIM_FLOW_ERROR.endpoint.request

Configuration Properties

Ref	Action	Subject	Description
NXT-20626	Added	ohi.CLAIM_FLOW_ERROR.endpoint.request	If the claims flow raises a technical error, the system will send a notification to the endpoint specified in the ohi.CLAIM_FLOW_ERROR.endpoint.request system property. If the system property or the value of that system property is not set, then the flow will not send a notification. Note that this is not a new system property. The system uses the allready existing ohi.{0}.endpoint.request system property for this where {0} = CLAIM_FLOW_ERROR.

Ref

Action

Subject

Description

NXT-20626

Added

ohi.CLAIM_FLOW_ERROR.endpoint.request

If the claims flow raises a technical error, the system will send a notification to the endpoint specified in the ohi.CLAIM_FLOW_ERROR.endpoint.request system property. If the system property or the value of that system property is not set, then the flow will not send a notification. Note that this is not a new system property. The system uses the allready existing ohi.{0}.endpoint.request system property for this where {0} = CLAIM_FLOW_ERROR.

Web Services

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Data Conversion

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Dynamic Logic

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UI Changes

Ref	Action	Subject	Description
NXT-22209	Removed	Reference sheets	Reference sheets Tile should not be visible

Ref

Action

Subject

Description

NXT-22209

Removed

Reference sheets

Reference sheets Tile should not be visible

Deprecated items (to be removed in future release)

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Breaking Changes

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Bug Fixes

BugDB	SR	Internal	BP	Summary
31931061	3-24111363781	NXT-21171		Flexcode field not saving on claim save
Description:	While updating flexcode (yes/no) on claimline, in certain scenario’s the new value of the field is not being saved. This happens typically when multiple claims lines are updated.
Resolution:	Flex Code fields are saved correctly now even when multiple claim lines are updated.
32139431	3-24383895551	NXT-21456		CMT data set containing flex codes systems and flex codes take more time than 3.20.2.0.0
Description:	CMT data set containing flex codes systems and flex codes take more time than 3.20.2.0.0 release.
Resolution:	The performance of importing flex codes through CMT is optimized now.
32219860	3-24628242821	NXT-21650		Applied provider pricing clause on claim line does not change when product category is changed
Description:	Changing the associated Product with the Product Category does not reflect a change in the applied provider pricing clause on the claim line.
Resolution:	When a Product in the Product Category Dimensions is changed, the claim line is now correctly calculating the Applied Provider Pricing Clause on unfinalize and submit.
32529906	3-25047894481	NXT-22099	BP	Claims Reprocess Integration Point should mark the existing pend reasons as resolved
Description:	Pend resolution details do not show resolved_date_time, resolved_by_user etc in the pend reason history when the pend is resolved during claims reprocess via 'api/claimsreprocess and api/claimsreprocesscriteria' IP.
Resolution:	Now the existing pend reasons are marked as resolved with timestamp using the information from the user context. This is logged in user for online reprocessing request and system user for batch reprocessing requests.
32554892	3-25162308611	NXT-22161	BP	Duplicating a claim line which has a value for an Overriding Claim Line parameter gives error
Description:	Duplicating a claim line which has a value for an Overriding Claim Line parameter gives the below error : GEN-ORA-00001: THIS CLAIM LINE OVERRIDE ALREADY EXISTS Expectation is that no error message should be shown and claim line should be added without any errors.
Resolution:	Duplicating a claim line which has a value for an Overriding Claim Line parameter does not give error anymore. Now if a claim line has values for any of the below fields, then those values will not be available in the new duplicated line. Family Code Coverage Regime (Auth) Funding Arrangement Product Family Product Line Product Coverage Specification Coverage Regime (No Auth) Post Benefits Regime Waiting Period Regime Authorization Regime
32590339		NXT-22209		Reference sheets UI page is not usable in this release.
Description:	Reference sheets UI page is not usable in this release.
Resolution:	Reference sheets Tile is removed
32626173	3-25359046661	NXT-22262	BP	Currency conversion (payment) signature executed once per claim
Description:	Exchange rates are calculated incorrectly if the dates on claims lines differ from the last claim line. Conversion (Payment) signature dynamic logic is only executed once per claim for claim line with the most recent start date, instead of per claim line.
Resolution:	Exchange rates are now calculated correctly for each claim line with different dates. Conversion (Payment) signature dynamic logic is executed for claim lines based on distinct start date, instead of once per claim.

BugDB

Internal

Summary

31931061

3-24111363781

NXT-21171

Flexcode field not saving on claim save

Description:

While updating flexcode (yes/no) on claimline, in certain scenario’s the new value of the field is not being saved. This happens typically when multiple claims lines are updated.

Resolution:

Flex Code fields are saved correctly now even when multiple claim lines are updated.

32139431

3-24383895551

NXT-21456

CMT data set containing flex codes systems and flex codes take more time than 3.20.2.0.0

Description:

CMT data set containing flex codes systems and flex codes take more time than 3.20.2.0.0 release.

Resolution:

The performance of importing flex codes through CMT is optimized now.

32219860

3-24628242821

NXT-21650

Applied provider pricing clause on claim line does not change when product category is changed

Description:

Changing the associated Product with the Product Category does not reflect a change in the applied provider pricing clause on the claim line.

Resolution:

When a Product in the Product Category Dimensions is changed, the claim line is now correctly calculating the Applied Provider Pricing Clause on unfinalize and submit.

32529906

3-25047894481

NXT-22099

Claims Reprocess Integration Point should mark the existing pend reasons as resolved

Description:

Pend resolution details do not show resolved_date_time, resolved_by_user etc in the pend reason history when the pend is resolved during claims reprocess via 'api/claimsreprocess and api/claimsreprocesscriteria' IP.

Resolution:

Now the existing pend reasons are marked as resolved with timestamp using the information from the user context. This is logged in user for online reprocessing request and system user for batch reprocessing requests.

32554892

3-25162308611

NXT-22161

Duplicating a claim line which has a value for an Overriding Claim Line parameter gives error

Description:

Duplicating a claim line which has a value for an Overriding Claim Line parameter gives the below error : GEN-ORA-00001: THIS CLAIM LINE OVERRIDE ALREADY EXISTS
Expectation is that no error message should be shown and claim line should be added without any errors.

Resolution:

Duplicating a claim line which has a value for an Overriding Claim Line parameter does not give error anymore. Now if a claim line has values for any of the below fields, then those values will not be available in the new duplicated line.
Family Code
Coverage Regime (Auth)
Funding Arrangement
Product Family
Product Line
Product
Coverage Specification
Coverage Regime (No Auth)
Post Benefits Regime
Waiting Period Regime Authorization Regime

32590339

NXT-22209

Reference sheets UI page is not usable in this release.

Description:

Reference sheets UI page is not usable in this release.

Resolution:

Reference sheets Tile is removed

32626173

3-25359046661

NXT-22262

Currency conversion (payment) signature executed once per claim

Description:

Exchange rates are calculated incorrectly if the dates on claims lines differ from the last claim line. Conversion (Payment) signature dynamic logic is only executed once per claim for claim line with the most recent start date, instead of per claim line.

Resolution:

Exchange rates are now calculated correctly for each claim line with different dates. Conversion (Payment) signature dynamic logic is executed for claim lines based on distinct start date, instead of once per claim.

Issues that were backported in previous Release / Patch

No backports.