Release Notes for Oracle Health Insurance Claims Adjudication Patch 4.23.1.0.5

This document contains the release notes for Oracle Health Insurance Claims Adjudication Patch 4.23.1.0.5.

Version compatibility: Oracle Health Insurance Claims Adjudication Release 4.23.1.x is only compatible with other Oracle Health Insurance applications release version 4.23.1.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 Patch

NXT-27561

Selective financial limit carryover

This enhancement introduces the ability to decide whether an out-of-pocket-maximum (OOPM) limit consumption counts towards year-end carryover. For example: * An OOPM consumption from a coinsurance or a copay do not count towards a carryover. * An OOPM consumption from a deductible does count towards a carryover.

A new indicator, exclude from carry over is introduced on the product-benefit-specification limit to help make this decision. The decision acts as input to evaluate a coverage regime.

Documentation Links:
Configuration Guide - Adjudication Limits
Configuration Guide - Product Benefit Specification Limit

NXT-28020

Attach additional diagnoses to a claim

This enhancement introduces new predefined methods to replace diagnosis codes in a claim or claim line as part of the automated process flow.

The methods help map one type of diagnosis coding system to another, for example, from ICD-9 to ICD-10.

Documentation Links:
Developer Guide - addDiagnosis and deleteDiagnosis

Upgrade Steps for Installation

To perform the upgrade, perform the following steps:

  1. Perform any pre-upgrade steps.

  2. Stop all the managed nodes running the existing version of the application.

  3. Perform any pre-undeploy steps.

  4. Undeploy the existing version of the application.

  5. Back up the database.

  6. Perform any post-undeploy steps.

  7. Unpack the release bundle into a directory that we refer to as OHI_ROOT from now on.

  8. Change Installation Configuration: In <OHI_ROOT>/util/install, make a copy of ohi_install.cfg.template and name it ohi_install.cfg.

  9. Edit ohi_install.cfg to contain your specific database connection data and other configuration settings. The settings are explained in the file itself.

  10. Make sure NO connections are present to the database using the OHI_xxx_USER account (where xxx is the abbreviation of the application)

  11. 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 .

  12. Make the required changes to the ohi properties file

  13. Perform any post-upgrade steps

  14. Start WebLogic application server

  15. Deploy the Application

  16. Perform any post-deploy steps

Configuration Properties

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Web Services

Ref Action Description

NXT-27561

Modified

Product Benefit Specification Integration Point

Added Exclude From Carry Over indicator on product benefit specification limits

Data Conversion

Ref Action Description

NXT-27561

Added

Product Benefit Specification Limit

Exclude From Carry Over indicator set to false

Dynamic Logic

Ref Action Description

NXT-28020

Added

deleteDiagnosis

This method removes a diagnoses code from a claim or claimline through dynamic logic within a derivation rule.

NXT-28020

Added

addDiagnosis

This method is adds a diagnoses code to a claim or claimline through dynamic logic within a derivation rule.

UI Changes

Ref Action Description

NXT-27561

Modified

ADF Setup product benefit specifications

Added Exclude From Carry Over indicator

Breaking Changes

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Bug Fixes

BugDB SR Internal Summary

36427800

3-35684326321

NXT-29041

Gathering statistics on technical table for every extract activity is inefficient

Description:

Gathering statistics on technical table for every extract activity is inefficient as it was enabled by default for all cases and because of parallel extracts performance was degraded.

Resolution:

A check is added which will ensure statistics are gathered only in certain cases. Hence, improving the efficiency of extract activity.

Issues that were backported in previous Release / Patch

No backports.