Release Notes for Oracle Health Insurance Claims Adjudication Patch 3.21.3.0.6

This document contains the release notes for Oracle Health Insurance Claims Adjudication Patch 3.21.3.0.6.

Version compatibility: Oracle Health Insurance Claims Adjudication Release 3.21.3.x is only compatible with other Oracle Health Insurance applications release version 3.21.3.x unless explicitly stated otherwise.

In accordance with the OHI error correction policy (Document 1494031.1 on My Oracle Support), error correction support will be provided for this release and the previous two releases.

Enhancements

ID	Summary	Description	Included in Patch
NXT-22847	Denied claim for previous approved claim result into zero amount invoice in oracle finance SR	This change enables switching off the generation of accounting details for non-invoiced financial transactions during financial message generation. Before this change, the system always generated accounting detail for the non-invoiced financial transactions in the generated financial message. Even in the case that not one invoice was created for the handled financial transactions, there would always be an accounting detail in the message. Now this behavior can be switched off by setting the (new) system property 'ohi.financialmessage.create.noninvoiceaccdetail' to false. Besides, existing system generates empty XML and Flat File financial message even though there aren’t any invoiced data. This change also get rids of such empty financial messages.

Summary

Description

Included in Patch

NXT-22847

Denied claim for previous approved claim result into zero amount invoice in oracle finance SR

This change enables switching off the generation of accounting details for non-invoiced financial transactions during financial message generation. Before this change, the system always generated accounting detail for the non-invoiced financial transactions in the generated financial message. Even in the case that not one invoice was created for the handled financial transactions, there would always be an accounting detail in the message.

Now this behavior can be switched off by setting the (new) system property 'ohi.financialmessage.create.noninvoiceaccdetail' to false.

Besides, existing system generates empty XML and Flat File financial message even though there aren’t any invoiced data. This change also get rids of such empty financial messages.

Upgrade Steps for Installation

To perform the upgrade, perform the following steps:

Perform any pre-upgrade steps.
Stop all the managed nodes running the .existing version of the application.
Perform any pre-undeploy steps.
Undeploy the existing version of the application.
Back up the database.
Perform any post-undeploy steps.
Unpack the release bundle into a directory that we refer to as OHI_ROOT from now on.
Change Installation Configuration: In <OHI_ROOT>/util/install, make a copy of ohi_install.cfg.template and name it ohi_install.cfg.
Edit ohi_install.cfg to contain your specific database connection data and other configuration settings. The settings are explained in the file itself.
Make sure NO connections are present to the database using the OHI_xxx_USER account (where xxx is the abbreviation of the application)
Run the Upgrade script:
1. Open a command window and browse to <OHI_ROOT>/util/install.
2. Run the upgrade by executing ./ohi-update.sh .
Make the required changes to the ohi properties file
Perform any post-upgrade steps
Start WebLogic application server
Deploy the Application
Perform any post-deploy steps

Configuration Properties

Ref	Action	Subject	Description
NXT-22847	Added	ohi.financialmessage.create.noninvoiceaccdetail	Decides the creation of non-invoice accounting details in financial message. If set to true, activity will create non-invoice account details in financial message. If the property is set to 'false', non-invoice accounting details won’t be created. Default value is true.

Ref

Action

Subject

Description

NXT-22847

Added

ohi.financialmessage.create.noninvoiceaccdetail

Decides the creation of non-invoice accounting details in financial message. If set to true, activity will create non-invoice account details in financial message. If the property is set to 'false', non-invoice accounting details won’t be created. Default value is true.

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-24082	Modified	amount field	The amount value should be restricted by the min or max range as specified by the metadata with maximum precision set to 4 decimal places. If metadata has decimal limit 1- 4 then use the same in UI else if it is more than 4 in metadata then truncate the decimal length to 4.

Ref

Action

Subject

Description

NXT-24082

Modified

amount field

The amount value should be restricted by the min or max range as specified by the metadata with maximum precision set to 4 decimal places. If metadata has decimal limit 1- 4 then use the same in UI else if it is more than 4 in metadata then truncate the decimal length to 4.

Deprecated items (to be removed in future release)

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Breaking Changes

This section intentionally left blank.

Bug Fixes

BugDB	SR	Internal	BP	Summary
33149756	3-25364034307	NXT-23079		Claim line limit section is not involved in choosing the limit to be applied
Description:	As per current behavior, claim line limit is only used to override the limit height of the applied limit(chosen by count towards limit or prod ben spec parameter). But it is expected that claim line limit by itself can determine the limit to be applied on the claim line.
Resolution:	When there aren’t any count toward limits configured, limits configured at claim line level are evaluated and out of those only one is selected based on product and cover withhold rule category comparison as mentioned below: Product should be mentioned at claim line limit Product mentioned at claim line and claim line limit should be same If cover withhold rule category isn’t null then category mentioned on claim line limit should be same as category mentioned in cover withhold rule First claim line limit which satisfies above comparison is returned. If there isn’t any matching claim line limit, following check happens again on list of configured claim line limits. Product shouldn’t be mentioned at claim line limit Cover withhold rule category mentioned at claim line limit should be same as category mentioned in cover withhold rule First claim line limit which satisfies above comparison is returned.
33404798		NXT-23414		Counters IP creates carry over counter periods with current amount zero for calendar year limits
Description:	For certain calendar year limits with renewal period of one year and a carry over period, when an external consumption is created such that it count towards carry over period, counter period for carry over period is created with zero value.
Resolution:	Counter Period for carry over period will have the appropriate consumption amount rather than being 0.
33426065		NXT-23453		Allow updating claim line rule coverages using patch operation on claim
Description:	This change allows user to update claim line rule coverages using patch operation on claims generic API . On patch operation , manually changed claim line rule coverages are evaluated when reprocess variable is set to true .
Resolution:	Updating claim line rule coverage is allowed using claim patch operation.
33581072	3-26738959731	NXT-23830	BP	Selected coverage specification is filtered out on provider group scope
Description:	The overriding coverage specification is filtered out as part of benefit selection process on provider group scope, which should not happen. Filter benefit selection process is skipped when an overriding coverage specification is selected.
Resolution:	Selected coverage specification is not filtered out on provider group scope.
33750606		NXT-24078	BP	Flex code definition page: have to click twice on the save button when editing an existing record.
Description:	After clicking Edit and then Save Button, on Flex code definition page, the page remains in Edit mode. Clicking on Save Button again will only save data and the page will be in View mode.
Resolution:	View mode is shown on the page after Edit and Save action.
33752133		NXT-24082	BP	The amount value precision is set to 4 decimal places, it should ideally be 2 decimal places
Description:	The amount value should be restricted by the min or max range as specified by the metadata with maximum precision set to 4 decimal places. If metadata has decimal limit 1- 4 then use the same in UI else if it is more than 4 in metadata then truncate the decimal length to 4.
Resolution:	The amount value is restricted by the min or max range as specified by the metadata by using max and min precision to set decimal places by taking decimal length from metadata for moneyFieldValidator. decimal limit is set to 4 as specified in metadata, if it exceeds 4 then will be truncated using roundingMode as FLOOR.
33762901		NXT-24101	BP	User is not able to create a new insurable entity type as person from JET UI
Description:	Entering a new Insurable Entity Type is not possible in the JET UI (PERSON). It throws an error that the access restriction already exists
Resolution:	User is able to create a new insurable entity type as person from JET UI
33776093	3-28212142701	NXT-24120	BP	Error when user changes the procedure in claim line
Description:	When user tries to change the procedure code in claim line, it fails with message having exception stack trace.
Resolution:	SQL query which is used to fetch procedure codes was getting failed due to having more than 1000 values in its IN clause. Replaced list of values by subquery in IN clause.
33787409		NXT-24139	BP	Dynamic field created twice when a error is raised while saving it to floorplan.
Description:	In Usages Page while performing the 'Add To Floorplan' action, when an error occurs while saving, usage is added twice in the floorplan if the error is resolved and saved.
Resolution:	Fix was made to avoid multiple additions of usage when an error occurs while performing the 'Add To Floorplan' action.
33796165	3-28412233731	NXT-24152	BP	SELECT_TRANSACTION_INTO_SET activity fails for claims which have multiple versions but no reversals
Description:	SELECT_TRANSACTION_INTO_SET activity fails with general processing error while creating financial transaction set. This happens when there are claims which has multiple versions but has missing reversals
Resolution:	When claim is unfinalized, reversals are created as required. If same claim gets submitted twice simultaneously, there could be a chance that finalized claim gets processed again directly without un-finalizing it. It leads to missing reversal. Added check in task processing to allow processing of claims if it isn’t finalized.
33835458	3-28425351821	NXT-24212	BP	Purge job PURGE_TECHNICAL_DATA_DAILY is failing
Description:	'PURGE_TECHNICAL_DATA_DAILY' purge job fails with an invalid number exception when batch_id column of pri$fee_schedule_lines table holds alphanumeric value
Resolution:	Job compares batch_id against activity id. Explicitly converted activity id to character type to avoid conversion of batch_id to number.
33838616	3-26573250521	NXT-24216	BP	OHI should not allow concurrent submits
Description:	When a claim is submitted to Initialize Status, then from the records it is seen that the claim is submitted twice which has an impact on processing from Initialize status twice
Resolution:	If a claim is submitted twice, sometimes there is a change for the threads to create two separate tasks for initializing where one task will be completed and another task will be failed and will be in Initialize state, when the tasks are processed again the claim will execute from there even if the claim is in Finalized Status, now added a condition if the Finalized Claim is processed from the Initialize Processor the Task will be set to Dismissed and will not pick up again.
33854870	3-28461659251	NXT-24231	BP	Data replication fails with java.io.IOException error when OAuth authentication mechanism is used
Description:	Data replication fails with java.io.IOException error when OAuth authentication mechanism is used
Resolution:	Data replication now works with OAuth authentication mechanism

BugDB

Internal

Summary

33149756

3-25364034307

NXT-23079

Claim line limit section is not involved in choosing the limit to be applied

Description:

As per current behavior, claim line limit is only used to override the limit height of the applied limit(chosen by count towards limit or prod ben spec parameter). But it is expected that claim line limit by itself can determine the limit to be applied on the claim line.

Resolution:

When there aren’t any count toward limits configured, limits configured at claim line level are evaluated and out of those only one is selected based on product and cover withhold rule category comparison as mentioned below:

Product should be mentioned at claim line limit
Product mentioned at claim line and claim line limit should be same
If cover withhold rule category isn’t null then category mentioned on claim line limit should be same as category mentioned in cover withhold rule

First claim line limit which satisfies above comparison is returned. If there isn’t any matching claim line limit, following check happens again on list of configured claim line limits.

Product shouldn’t be mentioned at claim line limit
Cover withhold rule category mentioned at claim line limit should be same as category mentioned in cover withhold rule

First claim line limit which satisfies above comparison is returned.

33404798

NXT-23414

Counters IP creates carry over counter periods with current amount zero for calendar year limits

Description:

For certain calendar year limits with renewal period of one year and a carry over period, when an external consumption is created such that it count towards carry over period, counter period for carry over period is created with zero value.

Resolution:

Counter Period for carry over period will have the appropriate consumption amount rather than being 0.

33426065

NXT-23453

Allow updating claim line rule coverages using patch operation on claim

Description:

This change allows user to update claim line rule coverages using patch operation on claims generic API . On patch operation , manually changed claim line rule coverages are evaluated when reprocess variable is set to true .

Resolution:

Updating claim line rule coverage is allowed using claim patch operation.

33581072

3-26738959731

NXT-23830

Selected coverage specification is filtered out on provider group scope

Description:

The overriding coverage specification is filtered out as part of benefit selection process on provider group scope, which should not happen. Filter benefit selection process is skipped when an overriding coverage specification is selected.

Resolution:

Selected coverage specification is not filtered out on provider group scope.

33750606

NXT-24078

Flex code definition page: have to click twice on the save button when editing an existing record.

Description:

After clicking Edit and then Save Button, on Flex code definition page, the page remains in Edit mode. Clicking on Save Button again will only save data and the page will be in View mode.

Resolution:

View mode is shown on the page after Edit and Save action.

33752133

NXT-24082

The amount value precision is set to 4 decimal places, it should ideally be 2 decimal places

Description:

Resolution:

The amount value is restricted by the min or max range as specified by the metadata by using max and min precision to set decimal places by taking decimal length from metadata for moneyFieldValidator. decimal limit is set to 4 as specified in metadata, if it exceeds 4 then will be truncated using roundingMode as FLOOR.

33762901

NXT-24101

User is not able to create a new insurable entity type as person from JET UI

Description:

Entering a new Insurable Entity Type is not possible in the JET UI (PERSON). It throws an error that the access restriction already exists

Resolution:

User is able to create a new insurable entity type as person from JET UI

33776093

3-28212142701

NXT-24120

Error when user changes the procedure in claim line

Description:

When user tries to change the procedure code in claim line, it fails with message having exception stack trace.

Resolution:

SQL query which is used to fetch procedure codes was getting failed due to having more than 1000 values in its IN clause. Replaced list of values by subquery in IN clause.

33787409

NXT-24139

Dynamic field created twice when a error is raised while saving it to floorplan.

Description:

In Usages Page while performing the 'Add To Floorplan' action, when an error occurs while saving, usage is added twice in the floorplan if the error is resolved and saved.

Resolution:

Fix was made to avoid multiple additions of usage when an error occurs while performing the 'Add To Floorplan' action.

33796165

3-28412233731

NXT-24152

SELECT_TRANSACTION_INTO_SET activity fails for claims which have multiple versions but no reversals

Description:

SELECT_TRANSACTION_INTO_SET activity fails with general processing error while creating financial transaction set. This happens when there are claims which has multiple versions but has missing reversals

Resolution:

When claim is unfinalized, reversals are created as required. If same claim gets submitted twice simultaneously, there could be a chance that finalized claim gets processed again directly without un-finalizing it. It leads to missing reversal.

Added check in task processing to allow processing of claims if it isn’t finalized.

33835458

3-28425351821

NXT-24212

Purge job PURGE_TECHNICAL_DATA_DAILY is failing

Description:

'PURGE_TECHNICAL_DATA_DAILY' purge job fails with an invalid number exception when batch_id column of pri$fee_schedule_lines table holds alphanumeric value

Resolution:

Job compares batch_id against activity id. Explicitly converted activity id to character type to avoid conversion of batch_id to number.

33838616

3-26573250521

NXT-24216

OHI should not allow concurrent submits

Description:

When a claim is submitted to Initialize Status, then from the records it is seen that the claim is submitted twice which has an impact on processing from Initialize status twice

Resolution:

If a claim is submitted twice, sometimes there is a change for the threads to create two separate tasks for initializing where one task will be completed and another task will be failed and will be in Initialize state, when the tasks are processed again the claim will execute from there even if the claim is in Finalized Status, now added a condition if the Finalized Claim is processed from the Initialize Processor the Task will be set to Dismissed and will not pick up again.

33854870

3-28461659251

NXT-24231

Data replication fails with java.io.IOException error when OAuth authentication mechanism is used

Description:

Data replication fails with java.io.IOException error when OAuth authentication mechanism is used

Resolution:

Data replication now works with OAuth authentication mechanism

Issues that were backported in previous Release / Patch

BugDB	Internal	Summary	Backport	BugDB	SR
33149756	NXT-23079	Claim line limit section is not involved in choosing the limit to be applied	3.21.2.0.6	33763742	3-28317336971

BugDB

Internal

Summary

Backport

BugDB

33149756

NXT-23079

Claim line limit section is not involved in choosing the limit to be applied

3.21.2.0.6

33763742

3-28317336971