Release Notes for Oracle Health Insurance Claims Adjudication Patch 4.25.1.0.8

This document contains the release notes for Oracle Health Insurance Claims Adjudication Patch 4.25.1.0.8.

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-3641

Enhanced PHI logs access using base views

In SaaS deployments, PHI access logs are stored in the database for 60 days in the PHI_LOG_EVENTS table. Logs older than 60 days are moved to OCI Object Storage by a daily database scheduler job. Prior to this release, customers could query recent logs (≤ 60 days) using the logphievents generic API, but accessing older logs required raising an SR with the AMS team to retrieve files from OCI Object Storage.

This enhancement improves the customer experience by enabling PHI access logs to be extracted directly through base view generation. The PHI_LOG_EVENTS table is now included in base view generation, allowing customers to schedule a daily extract of the PHI_LOG_EVENTS_BV base view and load the extracted data into their own data warehouse for analysis and reporting.

An access restriction is created for PHI_LOG_EVENTS_BV, but it is not automatically granted to the ALL_VIEW_ACCESS_ROLE.

Documentation Links:
Administration Guide - Accessing PHI Logs in Oracle Health Insurance Cloud Services (OHI CS)
Developer Guide - Base Views Access Restrictions

CPN-3799

Operational Reports and Data Transfer

The following changes are made in Operational Reports and Data Transfer:

  • In the previous release, the CSV files generated by the Data Transfer IP did not include a header row. In this release, CSV files include the header.

  • In the previous release, when a query returned no records, the Data Transfer IP responded with HTTP 200 with an empty response body. This behavior is changed to return HTTP 204 (No Content).

  • Two new error messages are introduced in the Operational Reporting IP. The IP returns an HTTP 422 response with one of the following error messages:

    • OHI-IP-ORV-008: View {0} does not exist

    • OHI-IP-ORV-009: Access restriction grant is missing to query the view {0}

  • The following issues specific to On-Prem deployments are fixed:

    • Incomplete or truncated responses when querying very large data.

Documentation Links:
Developer Guide - Data Transfer Integration Point - Response
Developer Guide - Data Transfer Integration Point - CSV
Developer Guide - Operational Reporting Integration Point - Error Messages
Developer Guide - Data Transfer Integration Point - Response File Format

CPN-4025

Security logs retrieval via API and data transfer

Prior to this release, security logs were written only to the file system and were not accessible through any API. With this enhancement, SaaS customers can now retrieve security logs using a dedicated API as well as through the data transfer feature.

A new API, logsecurityevents, is introduced, backed by the new table LOG_SECURITY_EVENTS. A corresponding base view, PHI_LOG_SECURITY_EVENTS_BV, is now available to support extraction of security logs via the data transfer feature. This allows customers to schedule regular extracts (e.g., daily) and load the data into their own analytics or SIEM systems.

Access to security logs is controlled:

  • The access restriction for PHI_LOG_SECURITY_EVENTS_BV is created but not granted automatically to ALL_VIEW_ACCESS_ROLE.

  • A dedicated access role must be explicitly granted to users who are allowed to extract security logs.

The table LOG_SECURITY_EVENTS is included in auto-purge with a default retention period of 7 days.

Documentation Links:
Administration Guide - Fetch Security Logs through API
Administration Guide - Auto Purge

NXT-31925

Operational Reporting View - Daily claims count per claim process type

This enhancement introduces an operational reporting view of the daily claim count by process type. The report allows users to analyze and monitor daily claim volumes for each process type.

Documentation Links:
Operations Guide - Daily Claim Count by Process Type
Operations Guide - Date Filter

NXT-32383

Ability to un-resolve the pend on claim or line

This enhancement introduces the ability to unresolve a resolved pend reason on a claim or a claim line from the claims page.

Documentation Links:
Developer Guide - Unresolve Pend Reasons

NXT-32962

Implement Max Row Limit for Tab-Result Component

This enhancement introduces a maximum row limit of 100 for the Tab-Result Component. If the number of rows in the tab results exceeds 100, it is recommended to apply search criteria to view more records.

Documentation Links:
Developer Guide - Tab-Results

4.24.1.0.16

NXT-33070

Improved Multi-Select Behavior for Row Selection in Tables

The record-selection behaviour has now been updated to follow an additive selection model, ensuring that selecting a record no longer clears existing selections. All previously selected records will remain selected and will not be unintentionally deselected.

Prior to this implementation, when user selects multiple records using checkboxes, clicking anywhere on a another row (outside the checkbox) would deselect all selected records except the one that was clicked.

Checkbox behaviour is modified in these pages/dialogs

  • Fee Schedule Lines

  • Pricing Worksheet

  • Apply Template Drawer

  • Apply Options Drawer

NXT-33123

Additional features - Claims Page

With this enhancements the following features are added to claims page:

  • Ability to delete non system specific messages though claim and claim line summary. This functionality can be enabled by setting system property ohi.jsui.summary.message.delete.enabled to true.

  • Custom property claimDiagnosisListJET - This property allows to view claim level diagnoses information at the claim line level. This property can be added to the claim line table and claim line detail page.

Documentation Links:
Installation Guide - Application Properties

Configuration Properties

Ref Action Description

NXT-33123

Added

ohi.jsui.summary.message.delete.enabled

This property enables or disables the delete link in the claim/claimline summary for messages

Web Services

Ref Action Description

CPN-3799

Modified

Operational Reporting IP

Two new error messages are introduced in the Operational Reporting IP. The IP returns an HTTP 422 response with one of the following error messages:

  • OHI-IP-ORV-008: View {0} does not exist

  • OHI-IP-ORV-009: Access restriction grant is missing to query the view {0}

CPN-3799

Modified

Data Transfer IP

  • CSV files generated by the Data Transfer IP includes the header.

  • When the query returned no records, the Data Transfer IP responds with HTTP 204 (No Content).

Data Conversion

This section intentionally left blank.

Dynamic Logic

This section intentionally left blank.

UI Changes

Ref Action Description

NXT-31925

Modified

Operational Reports

New operational report DAILYCLAIMSCOUNTPERPROCESSTYPE added, new floorplan introduced for the same

NXT-32383

Modified

Claims Page (CL0172), ClaimLines Page (CL0206)

Unresolve link introduced for claim and claimline pend reasons which are resolved. Also toggle added in claimlines page to view claimline with unresolved pends

NXT-33123

Modified

Claims Page (CL0172)

Resolve action is visible as table action instead of sub menu

NXT-33123

Modified

Claims Page (CL0172)

Ability is added to delete a message from Summary by adding system property 'ohi.jsui.summary.message.delete.enabled' and disabling messages tab configurations

NXT-33123

Modified

Claims Page (CL0172)

Ability added with custom property claimDiagnosisListJET to display inheritance at claimline level

NXT-33123

Modified

Claims Page (CL0172), ClaimLines Page (CL0206)

Added Seq and claim line code columns to claim line table search results. Added maxColWidth for Seq, KP, KB, Allowed #, Covered #  columns in system floorplan for claims, claimlines, subclaims

Breaking Changes

Ref Action Description

Access Restrictions

Ref Action Description

NXT-32383

Added

Unresolve Pend IP

New access restriction introduced for Unresolve Pend IP

Bug Fixes

BugDB SR Internal Summary

38591657

NXT-32846

Formatted name is not displayed in Claims Search page

Description:

Service member should show Member ID, formatted name , but formatted name is missing.

Resolution:

Formatted name is shown in search and details page

38706440

NXT-33115

Unfinalizing a claim does not display error on screen if no 'Source Reference' value is provided

Description:

Unfinalizing a claim using an Unfinalize Reason for which Source Reference is mandatory and no value is provided for it, no error is shown on screen. This happens when a Claim Transaction Event Rule is applicable for a claim.

Resolution:

Unfinalizing a claim using an Unfinalize Reason for which Source Reference is mandatory and no value is provided for it, an error is shown on screen when a Claim Transaction Event Rule is applicable for the claim.

38681084

NXT-33035

Claim line - LOV values are not populated in Remove Messages dialog

Description:

When user adds a message to claim and clicks on Remove messages dialog, LOV value’s are not populated

Resolution:

Messages are shown in the Remove Messages dialog even in the flow when user adds a new message

38672154

NXT-33017

Number of records is shown as '0' in Widgets when users scroll to the end

Description:

In widgets query if there is a groupBy clause and no aggregate functionality, there is extra api query resulting in zero records due to which the number of records count is shown as 0.

Resolution:

Count is shown as based on totalResults returned in the respose

Issues that were backported in previous Release / Patch

No backports.