Release Notes for Oracle Health Insurance Claims Adjudication Patch 4.25.1.0.21

This document contains the release notes for Oracle Health Insurance Claims Adjudication Patch 4.25.1.0.21.

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

CPN-3975

Optimized memory usage during dynamic field/records retrieval and activity processing through chunking strategy

Memory utilization is improved during the retrieval of dynamic fields and records in the dynamic logic. A new predefined method, getDynamicRecordsByType, is introduced to retrieve dynamic records based on the field usage name (refer to "Predefined Methods" in the Developer Guide for details).

Write access is enabled for all dynamic fields of attachedPolicyData within "Policy Calculation Period Segments", allowing these fields to be modified using Groovy-style property access instead of the setDynamicField method (see "Policy Calculation Period Segments" in the Developer Guide).

Additionally, activity processing chunking is introduced to further optimize memory usage. When enabled, activity groups are processed based on a configurable chunk size (default 100 MB), and transactions are committed once the defined threshold is reached to prevent excessive memory consumption, after which processing continues for the remaining activities of the group within the same iteration.

NXT-32464

Non-Unique Provider Identifiers

This enhancement introduces enables the configuration setting that controls whether a provider identifier is unique across providers.

NXT-33750

Enhance UI download functionality to include all search results based on query criteria.

This enhancement extends the UI download feature to export the complete search result dataset matching the active query for select pages in claims and product definition application

Claims

  • Draft provider pricing clauses (worksheet and across)

  • Pricing Option – Partial Provider Pricing Causes Tab

  • Reference sheets

  • Product benefit specification

  • Benefit specifications

  • Claims Search

  • Authorization Search

  • Claim Lines Tab

  • Adjudication Limit Consumption Tab

  • Fee schedule lines

  • Procedure group details

  • Diagnosis group details

Product Definition

  • Product service definition (product and across)

  • Generated Benefits Specifications ( product )

  • Benefits Specification

In addition, multiple pages based on floorpan templates 1) View and Edit Table, 2) Search Object - List, 3) Search Object - table and 4) Tab tables/list (exception dynamic records) within View and Edit HRR now support download API based download feature.

NXT-33780

Ability to build and Validate multiple draft provider pricing clauses across worksheet

This enhancement introduces ability to build/validate multiple draft provider pricing clauses across multiple worksheets by removing the restriction of 10 distinct worksheet.

Configuration Properties

Ref Action Description

NXT-33750

Added

ohi.api.download.max.rows

The ohi.api.download.max.rows system property, which allows users to configure the maximum number of rows that can be downloaded through the Download API.

By default, this property is set to 2,000 rows. The maximum supported value is capped at 10,000 rows.

Web Services

Ref Action Description

NXT-32464

Modified

Provider IP

If more than 1 provider is matched to an identifier, then an error message is thrown

Data Conversion

Ref Action Description

NXT-32464

Removed

Provider Identifiers

Unique constraint on identifier and identifier type is dropped in all the applications.

Dynamic Logic

This section intentionally left blank.

UI Changes

Ref Action Description

NXT-33750

Modified

All floorplan based pages (and Reference Sheet Lines)

API based download is enabled in UI pages.

However, there is an exclusion list application wise:

  • Claims - Object Navigation Links, Provider Pricing Clause, Payment Registrations, Field Definitions, System Events, Insurable Entity Types, Adjudication Limits Search

  • Proddef - Object Navigation Links, Service Definitions, Product Export Sets, Global Activities, Field Definitions, System Events

Also, UI based download is retained in Extensibility tabs and tabs of some Detail pages:

  • Claims - Fee Schedules (Fee Schedule Lines), Transaction Sources (Transaction Source Usages), Products (Product Limits), Banks (Addresses, Bank Account Number Relations), tabs in all the Pricing Rule pages

  • Proddef - Parameter Aliases (Parameter Alias Values), Products (Cost sharing, Product provider Group, Product Limit Renewal)

NXT-33750

Modified

Proddef - Product Service Definition (Products and Across)

Boilerplate text value is updated for all the Regime fields to indicate the type of regime

Breaking Changes

Ref Action Description

NXT-33750

Modified

Below breaking change will be observed for UI download enhancement.

  • Date / date time fields are not formatted.

  • For system enumerations ( example status field on claim) key will be download.

  • For composite columns - example when two different fields were shown in one column in UI, download will have columns per value. Example instead of one column for formatted name, download will have separate columns for first name, middle name , last name and so on. Another example is maximum value / current value in counters, and setup pages, in download separate columns will be present for maximum/current days, units and amount.

  • Product service definition - download will show separate columns for each regime.

  • In UI if a custom list of value is added on a native field / string field using floorplan based configuration, only native data will be part of download - example - partial provider pricing clauses only method code will be download

Access Restrictions

This section intentionally left blank.

Bug Fixes

BugDB SR Internal Summary

39435432

4-0002835185

NXT-34256

Workflow events are now created correctly for claims with multiple pend reasons

Description:

When a claim had multiple pend reasons in Manual Adjudication, accepting the claim after resolving one pend reason did not correctly continue the workflow for the remaining unresolved pend reasons.

Resolution:

This issue has been resolved. After one pend reason is resolved, the workflow task for that pend reason is completed and a new workflow event is created for the next unresolved pend reason. The claim continues to return CLA-CLAI-035 until all relevant pend reasons are resolved.

39483107

NXT-34303

Diacritic search returns incorrect results for reserved words and special characters

Description:

Diacritic search returned incorrect results when search values contained reserved words or special characters.

Resolution:

Diacritic search now returns the correct results for values that contain reserved words or special characters.

39539021

4-0002915946

NXT-34346

Tab table inline row action does not select claimline row before view/open action

Description:

In the JET claims page, when a claim line tab table row has only two row actions, the actions are rendered as direct clickable icons. Clicking the view/open icon does not select/check the row. When users opens a pended claim line in edit mode and clicks to resolve pend on claim line pend reason tab, a popup appears to confirm pend resolution. When user clicks 'OK', nothing happens.

Resolution:

It is now possible to resolve pend on claim lines from claim line pend reason tab even though only 2 row actions are enabled

39570597

4-0002916902

NXT-34384

Claim line tab procedure details are cleared off when user navigates from claimline detail page

Description:

When a procedure is not configured in the Claim Lines Floor Plan and user navigates to claim lines detail page, clicks on Apply button, the data in the Claim Lines tab table is cleared off.

Resolution:

Procedure details are retained in claimlines tab table even when the fields are not included in details page floorplan

39564250

4-0002952166

NXT-34372

Resolve pend prompt defaults to Cancel when pressing Enter key on claims pend screen

Description:

When user clicks the Resolve link for the claim pend reason, the Resolve Pend pop-up opens. If the user presses Enter on the keyboard instead of resolving the pending reason, the Cancel action is triggered.

Resolution:

Resolve pend prompt defaults to Ok when pressing Enter key on claims pend screen and the pend is resolved. The issue is also fixed in Search Claim lines, claim line tab table, Large Claims page

39524374

NXT-34335

The zip generated by object generation endpoint includes Claim.groovy references to SubClaimHolder and SubClaimLineHolder, but does not include generated Groovy files for those holder classes.

Description:

The object generation endpoint builds the zip from classes known to the metamodel. SubClaimHolder and SubClaimLineHolder are non-persistable helper classes returned by Claim.getSubClaimHolder() and Claim.getSubClaimLineHolder(). Since they are not JPA/persistable classes and are not registered as auto-discoverable metamodel classes, they are not included in MetaModelImpl.getClasses() and therefore no Groovy skeleton files are generated for them. This causes the generated zip to contain references to missing classes.

Resolution:

Updated logic such that object generation endpoint builds the zip including SubClaimHolder.groovy and SubClaimLineHolder.groovy

39581245

4-0003050818

NXT-34400

Feeschedule lines does not have fee-schedule code in search in Config Migration Sets dialog

Description:

When users need to create configuration migration set, Fee-Schedule line dialog does not have fee-schedule code as one of the criteria in quick/advanced search for selection. Users won’t be able to add set of fee-schedule lines for specific set of fee-schedule codes in the package for migration.

Resolution:

Fee-schedule code in added to quick and advanced search for Fee Schedule Lines Config Migration Sets dialog

39450749

4-0002615815

NXT-34267

Reference Sheet searches may not display recently updated records immediately in non-production environments because of search index synchronization delays

Description:

Previously, updates made through the Reference Sheet maintenance process might not immediately appear in search results due to the configured search index synchronization interval. To improve the user experience in non-production environments, the indexing behavior for Reference Sheet data has been changed from periodic synchronization to on-commit indexing. This allows search results to reflect committed changes immediately, making testing and validation activities more efficient.

Resolution:

Fix is provided in non-production environments to address delays between Reference Sheet data updates and search index synchronization. With this change, search results now reflect committed updates immediately, eliminating the temporary inconsistency where recently modified records were not available in search results until the next index synchronization cycle.

38868763

4-0001673378

NXT-33408

LARGE_CLAIM_SUBMIT activity always fails if any sub claim is having existing errorred task

Description:

If sub claim is having ERRORED task (ClaimEvent), submitting large claim always results into "Submit activity of type LARGE_CLAIMS_SUBMIT failed, click on view for more details" error.

Resolution:

If sub claim is having ERRORED task (ClaimEvent), submitting large claim does not result in an error.

39618760

4-0003063146

NXT-34456

Remove Message from the claim line More menu causes a stale claim version error on Save

Description:

When a claim is in edit mode, removing a claim line message through the bulk/action dropdown sends a PATCH request that updates the claim on the server. This increments the claim version, but the UI did not refresh the claim header/object version afterward. As a result, the next explicit Save submitted the old version and Claims raised an optimistic locking error: the claim had changed since it was last read.

Resolution:

After a successful remove-message PATCH, the UI now reloads the claim objectVersionNumber and updates the in-memory claim before the user saves, so the subsequent Save uses the current version and no longer triggers GEN-RULE-020.

39561667

4-0002489461

NXT-34369

External consumption create or resolve counter periods using an incorrect period when explicit startDate and endDate are provided in the request.

Description:

When external consumptions were processed for a counter with existing historical consumptions, the requested consumption startDate and endDate could be incorrectly modified during counter period interval calculation. This could cause the system to either create a counter period with an incorrect start date or fall back to an existing counter period instead of creating the expected new counter period. This was observed when the aggregation level/product changed, and also when the aggregation level/product remained the same.

Resolution:

The counter period calculation logic now preserves the external consumption request dates while evaluating historical consumption intervals. If no applicable counter period exists, the new counter period is created using the startDate and endDate passed in the external consumption request.

39547633

4-0002944710

NXT-34354

Pre-pricing derived claim diagnoses are not considered for benefit specification diagnosis group matching

Description:

When claim diagnoses are added through a pre-pricing derivation rule using the claim.addDiagnosis() method, the derived diagnoses are not considered during benefit specification evaluation for diagnosis groups with usage scope "In" when no diagnosis type is defined on the benefit specification.

As a result, benefit specification selection fails and the claim processing returns error CLA-FL-BENS-019, even though the derived claim diagnoses should satisfy the diagnosis group criteria.

Resolution:

Benefit selection now correctly considers diagnoses that are added by pre-pricing derivation rules, including diagnoses added at both the claim level and the claim line level. This ensures that benefit specifications with diagnosis group criteria are evaluated using the latest diagnosis information available on the claim.

38121664

NXT-31926

Adjudication Limit Counters: Unable to fetch claim code under limit consumptions quick search

Description:

In Adjudication Limit Counters page, unable to fetch claim code in limit consumptions section

Resolution:

Quick search now works on claim code and Description. Advanced search has also been added based on 3 fields - Reserved?, Service Date and Transaction Date

39410117

NXT-34225

Undefined Value Appears in Certain Fields of Copied Claim Lines

Description:

When user copies a claimline and navigates to the claim line details page for the copied row, updates a few details, and clicks Back to Claim then some fields are not updated, and undefined appears in the currency field.

Resolution:

Proper values are retained/updated in currency field of claimline table

39505599

4-0002904344

NXT-34321

CTR Claim and CTR Claim Line Message banners display only message text

Description:

Message code is not displayed in CTR Claim and CTR Claim Line Message banners.

Resolution:

CTR Claim and CTR Claim Line Message banners to display both message code and text

39536040

4-0002914777

NXT-34342

User with Retrieve Access to 'CL0172' is able to push claims using IP

Description:

User with only Retrieve Access to Claims page 'CL0172' is able to push claims into OHI claims using ClaimsIn IP "/api/claims".

Resolution:

Removed the ClaimsIn IP mapping for Claims page access 'CL0172'. So, users with only Retrieve Access to 'CL0172' cannot insert claims using /api/claims

Issues that were backported in previous Release / Patch

No backports.