Release Notes for Oracle Health Insurance Claims Adjudication Patch 4.25.1.0.22

This document contains the release notes for Oracle Health Insurance Claims Adjudication Patch 4.25.1.0.22.

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

No enhancements.

Configuration Properties

This section intentionally left blank.

Web Services

This section intentionally left blank.

Data Conversion

This section intentionally left blank.

Dynamic Logic

This section intentionally left blank.

UI Changes

This section intentionally left blank.

Breaking Changes

This section intentionally left blank.

Access Restrictions

This section intentionally left blank.

Bug Fixes

BugDB SR Internal Summary

39463327

4-0002696651

NXT-34287

Init condition is not applied for tab table row region fields

Description:

When an initCondition is configured for a field placed under tab → table → row → region, the condition is not applied during table row initialization. The same condition works correctly when the field is configured under tab → table → row → columns.

Resolution:

Init conditions are working for tab table row region fields

39568098

4-0002904879

NXT-34381

Manual pricing does not retain allowed amount on a denied claim line

Description:

When claim line has a fatal message with origin pricing, on manually updating the allowed amount, Keep Pricing flag is not getting set.

Resolution:

If the claim line allowed amount or allowed number of units is updated, keep pricingnow gets checked regardless of the presence of fatal messages.

39709812

NXT-34554

RESEND_FIN_MSG_XML stores file content in DB while DataFile is marked as Object Storage

Description:

Resending financial messages could create files that could not be downloaded when Object Storage was enabled

Resolution:

Resent files are now stored consistently, allowing successful download through the data-file API

39756673

NXT-34615

Enhance Extend UI download feature to include full search result set

Description:

API based download has been enabled for all the pages.

Resolution:

  • A descriptive message will be displayed to the end user, indicating the number of rows being downloaded.

  • With this fix, all generic audit properties will be translated and displayed correctly.

  • In DPPC, the formatted name will be displayed.

Documentation Links for more Details:

39435276

NXT-34254

GEN-HTTP-004: Not Authorized – Access Restriction Issues Across Multiple Pages

Description:

Access role created with access grants CL0104, CL0104 Pricing Option JET Error : GEN-HTTP-004: Not Authorized (reimbursementmethods) Access role created with access grants CL0109, CL0109 Diminishing Rates JET Error : GEN-HTTP-004: Not Authorized (diminishingrates) Access role created with access grants CL0084, CL0084 Provider Limit Categories and Rules JET Error : GEN-HTTP-004: Not Authorized (providerlimitcategories)

Resolution:

Users with specific access to either Pricing Options, Diminishing Rates and Provider Limits page will not get Not Authorized HTTP error. Missing access restrictions are added to function API access table

39391424

4-0002762009

NXT-34195

Registration import can cause out of memory due to middle tier financial objects linking

Description:

During registration import, subject registration linking can lead to excessive heap growth and recurring out of memory events occassionally.

Resolution:

Registration import does not cause out of memory issues now.

38037152

3-40677679511

NXT-31779

Query API returns incorrect results for combined conditions

Description:

When you do a query search with a combination of a null, for instance (multicore.eq('Y').or.multicore.eq(null)), the result shows the records having value Y and not the ones with a null value.

Resolution:

When a query search is done with a combination of a null, the rows with null values are returned correctly.

39709767

4-0003030798

NXT-34552

Combination Check Uses Incomplete Claim Line Data During combination Check with ignoreHistory set to False

Description:

Functionally, the issue occurs when a pre-pricing rule derives procedure2 on claim lines and a later combination check depends on that derived value. During the first processing run, the triggering line sees the derived procedure2, but the candidate lines used for comparison may not, causing the combination check to miss a valid match. On reprocessing, the value is already saved, so the same check succeeds.

Resolution:

The issue was caused by current claim lines being re-read from history during combination check evaluation, so values derived earlier in the same processing flow were not always considered. This has been corrected so current claim lines are evaluated using the latest in-process values, ensuring derived fields such as procedure2 are available during combination checks.

39581979

4-0002809867

NXT-34402

Keep Benefits is not retained when Keep Pricing is not Specified

Description:

When a claim is sent out for processing and then returned, the benefits are not retained when Keep Benefits is checked and Keep Pricing is not specified.

Resolution:

If Keep Benefits is checked and Keep Pricing is not specified in the overriding claim, both Keep Benefits and Keep Pricing are set to true.

39526246

NXT-34337

PHI audit logs corrected for aliased base views in data transfer payloads

Description:

In specific data transfer scenarios, when a base view is queried through an alias and the Base View is outside of the Relation context, PHI logging was not generated.

Resolution:

The system now generates the PHI audit logs correctly for these aliased base view scenarios.

39526040

NXT-34336

PHI logging includes unmatched 'left joins' rows

Description:

When a query selects a PHI column from the right side of a LEFT JOIN, PHI logging is created for all rows from the left-side table, including rows where the joined row does not exist. In those cases the PHI column is effectively null, but a PHI log event is still written. This leads to incorrect PHI audit entries for rows that did not actually expose PHI.

Resolution:

When the joined column is marked as PHI but there is no match, no PHI Event is logged for that missing column.

39683214

NXT-34521

Activity purge fails with integrity constraint violation error.

Description:

Activity purge fails with an integrity constraint violation error because not all child data associated with the activity is cleaned up successfully.

Resolution:

Child data associated with the activity is now successfully deleted before the activity is purged.

39124688

NXT-33884

Adjudication Limit Counters: Consumption Percentage Incorrectly Displayed When Maximum Amount is Null for External Consumption

Description:

For an Amount Limit, when the first consumption is external, the counter period’s Maximum Amount remains null/empty, and only the current consumed amount is available.

In this scenario, the system still attempts to display consumption percentage (100%) and renders the pie chart. This is incorrect and misleading, as the percentage calculation depends on the availability of a defined maximum amount.

Resolution:

When the Maximum Amount is not available, then the distribution is not shown

39749217

NXT-34612

Claims Out response DataFiles configured for Object Storage cannot be downloaded

Description:

Claims Out response files configured for Object Storage could not be downloaded because their storage information was inconsistent

Resolution:

Claims Out response files are now written to the configured storage and can be downloaded. Previously affected files are corrected so their existing content remains accessible

39735308

NXT-34598

Able to add duplicate values in the combobox in Draft Provider Pricing Clauses page

Description:

Already selected values are still shown in the combobox in draft provider pricing clauses page

Resolution:

Only unique values are now displayed in the combobox

39233207

4-0002444462

NXT-34028

DataReplicationTargetSynchronization can remain Errored without spawning the next task

Description:

The DataReplicationTargetSynchronization task processor can leave the data replication functionality in a stopped state when task completion/error handling and next-task scheduling do not happen automatically.If that task failed during completion or while scheduling its successor, it could end in an Errored state without a follow-up task, causing configuration processing to stop until manual intervention.

Resolution:

The task error-handling flow was updated to create a follow-up DataReplicationTargetSynchronization Creator task when execution fails and the current task is marked Errored. This ensures configuration processing continues without requiring manual recovery.

39550844

NXT-34357

Claim settlement and unsettlement now require update grants on settlement reason access restrictions; create grants are no longer required

Description:

Users were incorrectly required to have create grants on the access restriction linked to a settlement reason when settling or changing the settlement reason of a claim. The documented claim settlement access behavior requires update access for settlement and unsettlement actions, while create grants are not used for these operations. This could prevent authorized users from settling or unsettling claims when they had the correct update grants but no create grant.

Resolution:

The settlement reason access validation was corrected to check update grants on the applicable settlement reason access restrictions. When replacing one settlement reason with another, the user must have update access to both the current settlement reason access restriction and the new settlement reason access restriction. If both grants are missing and the restrictions are different, two validation messages are returned, one for each access restriction, so the user can identify all missing grants.

39605475

4-0003069899

NXT-34436

Restrict Resolve Pendreason dialog to display pendreasons allowed by user access role

Description:

If a pend reason is access restricted, users who do not have access to that pend reason should not see it in the Resolve Pend Reason dialog.

Resolution:

The Resolve Pend Reason flow displays only the pend reasons the user has access to.

39477955

4-0002883878

NXT-34300

Sorting on a specific column of a multi value dynamic field does not sort column that has reftype in View mode

Description:

List of values columns in multi-value dynamic fields are not sorted according to sort criteria in View mode

Resolution:

All the columns of multi value dynamic field are sorted correctly based on sort criteria configured

39748793

NXT-34611

Config Migration Sets: Selected Rows Do Not Display Checked Checkbox

Description:

When user clicks on Show Selection button on "Select Specific" dialog, the selected items are being shown but corresponding check-boxes are not checked.

Resolution:

Now all checkboxes on the Show Selection dialog are checked by default, user can uncheck to un-select a selected item

39391275

4-0002715047

NXT-34193

Improve Claim page load performance for claims with high volume of claimlines

Description:

The Claim View/Edit page takes longer time to load when a claim has a very large number of claim lines and responsiveness is reduced. This is noticeable for large claims with hundreds or thousands of claim line records.

Resolution:

Improved the claim page loading flow so large claims open faster and remain more responsive. Existing claim behavior, validations, permissions, and displayed data remain unchanged.

Issues that were backported in previous Release / Patch

No backports.