Release Notes for Oracle Health Insurance Claims Adjudication Patch 4.25.1.0.12

This document contains the release notes for Oracle Health Insurance Claims Adjudication Patch 4.25.1.0.12.

Version compatibility: Oracle Health Insurance Claims Adjudication Release 4.25.1.x is only compatible with other Oracle Health Insurance applications release version 4.25.1.x unless explicitly stated otherwise.

As per the Service Description, you are obligated to request a service upgrade within 90 days of this release being generally available (GA). In line with the Oracle Cloud Services Pillar document, Section 4.2.2 End of Life, this release will be EOL in 12 months.

Enhancements

ID	Summary	Patch
NXT-32017	UI: Additional Features Advanced Search With this enhancement, the following multiple capabilities are added to the advanced search: Ability to select query operators for different search criteria. Ability to specify selected criteria as mandatory in advanced search. Multiple adjustments to reference sheet lines, page searches, and sort, including the ability to search on nulls, the ability to sort on start and end dates, view last updated by, and time details. Documentation Links: Developer Guide - JET UI - References - Components - Advanced Search
NXT-32032	Operational Reporting View - Daily Claims Productivity Per User This enhancement introduces an operational reporting view of the daily claims productivity per user. It allows users to analyze and monitor daily claims productivity per user. Documentation Links: Operations Guide - Daily Claims Productivity Per User
NXT-32040	Operational Reporting views for In or out-of-network provider service for any claim submission This enhancement will introduce an operational reporting view that provides information if a claim submitted is for an in-network or out-of-network provider service. Documentation Links: Operations Guide - In or out Provider Network information
NXT-32683	UI : Ability to view inherited Claim Header attributes on Claims Line This enhancement enables adding of the following fields from claim as read-only on claim line level (claims line table-column, table-more, and claim line detail page): claim→serviceMember claim→serviceProvider claim→locationProvider claim→referralProvider claim→serviceSpecialties claim→authorizationCode claim→emergencyIndicator claim→paymentReceiverRelation claim→paymentReceiverProvider claim→locationType Also, a new section Header Messages is added in Claimline summary section. Documentation Links: Developer Guide - JET UI - Properties - Claim’s Application Specific Custom Properties
NXT-33247	*UI: Procedure codes next to indPricePrincipalProcedures.* With this enhancement, the display of indPricePrincipalProcedures is adopted to show the related procedure code in the label. Documentation Links: Developer Guide - JET UI - Properties - Claim’s Application Specific Custom Properties
NXT-33467	UI : Claim and CTR Floorplan changes As part this enhancement, multiple changes to the floorplan w.r.t. the arrangement of subsections and additional information is displayed for claims. Documentation Links: Developer Guide - JET UI - Properties - Claim’s Application Specific Custom Properties
POL-18132	UI: Conditional display of row-level actions: edit and delete for tabs. This enhancement introduces the ability to control the display of actions (edit/delete) through initconditions. Documentation Links: Developer Guide - JET UI - References - Components - Conditions

Summary

Patch

NXT-32017

UI: Additional Features Advanced Search

With this enhancement, the following multiple capabilities are added to the advanced search:

Ability to select query operators for different search criteria.
Ability to specify selected criteria as mandatory in advanced search.
Multiple adjustments to reference sheet lines, page searches, and sort, including the ability to search on nulls, the ability to sort on start and end dates, view last updated by, and time details.

Documentation Links:
Developer Guide - JET UI - References - Components - Advanced Search

NXT-32032

Operational Reporting View - Daily Claims Productivity Per User

This enhancement introduces an operational reporting view of the daily claims productivity per user. It allows users to analyze and monitor daily claims productivity per user.

Documentation Links:
Operations Guide - Daily Claims Productivity Per User

NXT-32040

Operational Reporting views for In or out-of-network provider service for any claim submission

This enhancement will introduce an operational reporting view that provides information if a claim submitted is for an in-network or out-of-network provider service.

Documentation Links:
Operations Guide - In or out Provider Network information

NXT-32683

UI : Ability to view inherited Claim Header attributes on Claims Line

This enhancement enables adding of the following fields from claim as read-only on claim line level (claims line table-column, table-more, and claim line detail page):

claim→serviceMember
claim→serviceProvider
claim→locationProvider
claim→referralProvider
claim→serviceSpecialties
claim→authorizationCode
claim→emergencyIndicator
claim→paymentReceiverRelation
claim→paymentReceiverProvider
claim→locationType

Also, a new section Header Messages is added in Claimline summary section.

Documentation Links:
Developer Guide - JET UI - Properties - Claim’s Application Specific Custom Properties

NXT-33247

UI: Procedure codes next to indPricePrincipalProcedures.

With this enhancement, the display of indPricePrincipalProcedures is adopted to show the related procedure code in the label.

Documentation Links:
Developer Guide - JET UI - Properties - Claim’s Application Specific Custom Properties

NXT-33467

UI : Claim and CTR Floorplan changes

As part this enhancement, multiple changes to the floorplan w.r.t. the arrangement of subsections and additional information is displayed for claims.

Documentation Links:
Developer Guide - JET UI - Properties - Claim’s Application Specific Custom Properties

POL-18132

UI: Conditional display of row-level actions: edit and delete for tabs.

This enhancement introduces the ability to control the display of actions (edit/delete) through initconditions.

Documentation Links:
Developer Guide - JET UI - References - Components - Conditions

Configuration Properties

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Web Services

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Data Conversion

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Dynamic Logic

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UI Changes

Ref	Action	Description
NXT-32032	Added	Operational Reports New operational report 'DAILYCLAIMSPRODUCTIVITYPERUSER' added, new floorplan introduced for the same
NXT-32040	Added	Operational Reports New operational report 'PROVIDERNETWORKINFORMATIONS' added, new floorplan introduced for the same
NXT-32683	Modified	Claims Page (CL0172) Inheritance properties added to system floorplan
NXT-33247	Modified	Claims and CTR page (CL0172) Procedure code added as suffix to pricePrincipalProcedure indicators
NXT-33467	Modified	Claims and CTR pages (CL0172) System floorplans are modified - claims, claimlines, claimlinesviewonly, ctrclaims and ctrclaimlines

Ref

Action

Description

NXT-32032

Added

Operational Reports

New operational report 'DAILYCLAIMSPRODUCTIVITYPERUSER' added, new floorplan introduced for the same

NXT-32040

Added

Operational Reports

New operational report 'PROVIDERNETWORKINFORMATIONS' added, new floorplan introduced for the same

NXT-32683

Modified

Claims Page (CL0172)

Inheritance properties added to system floorplan

NXT-33247

Modified

Claims and CTR page (CL0172)

Procedure code added as suffix to pricePrincipalProcedure indicators

NXT-33467

Modified

Claims and CTR pages (CL0172)

System floorplans are modified - claims, claimlines, claimlinesviewonly, ctrclaims and ctrclaimlines

Breaking Changes

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Access Restrictions

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Bug Fixes

BugDB	SR	Internal	Summary
38519638		NXT-32719	Issues with 'Restrict to Methods' column on pricing option page
Description:	Restrict To Methods on Pricing Option Page provides only option to select fee-schedules
Resolution:	The Restrict to Method combobox has been replaced with a link that opens a drawer, allowing users to add Reimbursement Methods. The added methods are displayed in the corresponding table column.
38783292	3-42657322711	NXT-33240	There is no dataset build progress bar in Outbound exchanges page
Description:	There is no dataset build progress bar or status information is available for Outbound Configuration Exchange while the build is in progress. Users will have to wait for build to complete and a popup message to appear to confirm the build is completed!
Resolution:	A progress dialog is introduced to indicate that Build is in progress as soon as users clicks on Build icon in Outbound exchanges page
38884287	4-0001866311	NXT-33459	Episode Screen - Allows Edit via double click but does not save the details
Description:	In Episodes page, with double click on table results getting into inline edit mode but while saving changes are not saved(no API call)
Resolution:	When user double clicks and make changes in a row, they are saved once user clicks on Check icon
38885982	4-0001868127	NXT-33462	Claimline unlock option does not appear on Change screen
Description:	When user clicks on Change button, claims page opens in Edit mode. However, Unlock button is not available in More dropdown in edit mode.
Resolution:	Fix added to show the unlock option in edit mode also. Outstanding changes are saved along with Unlock
38497298		NXT-32680	Claims - Unable to select price individual provider LOV in claim lines, search is not working
Description:	Values are not displayed when user clicks on price individual provider LOV. User is not allowed to enter value in this LOV.
Resolution:	System Floorplan (Claims) is adjusted :refType of price individual provider is changed to "individualproviders" and similarly price organization provider to "organizationproviders"
38665720		NXT-33003	Claims Details page gets refreshed on clicking the history/notes link in previous version of the claim
Description:	Change the version LOV value from the working copy to any other version and open history/notes link. Immediately the claims details page gets refreshed and the claims history window is closed.
Resolution:	Claims page is not auto-refreshed on click of history or notes drawer
38883817	4-0001866219	NXT-33458	Episodes Page: frozen with no results upon search
Description:	When user makes a quick /advanced search in Episodes page on Insurable entity, page freezes and results in console error when there are no matching records
Resolution:	This issue is fixed and Episodes page will not freeze when there are no matching records upon search

BugDB

Internal

Summary

38519638

NXT-32719

Issues with 'Restrict to Methods' column on pricing option page

Description:

Restrict To Methods on Pricing Option Page provides only option to select fee-schedules

Resolution:

The Restrict to Method combobox has been replaced with a link that opens a drawer, allowing users to add Reimbursement Methods. The added methods are displayed in the corresponding table column.

38783292

3-42657322711

NXT-33240

There is no dataset build progress bar in Outbound exchanges page

Description:

There is no dataset build progress bar or status information is available for Outbound Configuration Exchange while the build is in progress. Users will have to wait for build to complete and a popup message to appear to confirm the build is completed!

Resolution:

A progress dialog is introduced to indicate that Build is in progress as soon as users clicks on Build icon in Outbound exchanges page

38884287

4-0001866311

NXT-33459

Episode Screen - Allows Edit via double click but does not save the details

Description:

In Episodes page, with double click on table results getting into inline edit mode but while saving changes are not saved(no API call)

Resolution:

When user double clicks and make changes in a row, they are saved once user clicks on Check icon

38885982

4-0001868127

NXT-33462

Claimline unlock option does not appear on Change screen

Description:

When user clicks on Change button, claims page opens in Edit mode. However, Unlock button is not available in More dropdown in edit mode.

Resolution:

Fix added to show the unlock option in edit mode also. Outstanding changes are saved along with Unlock

38497298

NXT-32680

Claims - Unable to select price individual provider LOV in claim lines, search is not working

Description:

Values are not displayed when user clicks on price individual provider LOV. User is not allowed to enter value in this LOV.

Resolution:

System Floorplan (Claims) is adjusted :refType of price individual provider is changed to "individualproviders" and similarly price organization provider to "organizationproviders"

38665720

NXT-33003

Claims Details page gets refreshed on clicking the history/notes link in previous version of the claim

Description:

Change the version LOV value from the working copy to any other version and open history/notes link. Immediately the claims details page gets refreshed and the claims history window is closed.

Resolution:

Claims page is not auto-refreshed on click of history or notes drawer

38883817

4-0001866219

NXT-33458

Episodes Page: frozen with no results upon search

Description:

When user makes a quick /advanced search in Episodes page on Insurable entity, page freezes and results in console error when there are no matching records

Resolution:

This issue is fixed and Episodes page will not freeze when there are no matching records upon search

Issues that were backported in previous Release / Patch

No backports.