Release Notes for Oracle Health Insurance Claims Adjudication Patch 4.25.1.0.4

This document contains the release notes for Oracle Health Insurance Claims Adjudication Patch 4.25.1.0.4.

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.
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-29960

Send enriched enrollment requests

This enhancement introduces the ability to include custom attributes in the enrollment request payload.

By enabling the option to add parameters and utilize them in building a response payload, the response can become more tailored to the specific situation of the claim.

Documentation Links:
Developer Guide - Enrollment Request Definition

NXT-30992

With this enhancement it is now possible to Copy Pricing Worksheet from an existing Worksheet

This enhancement enables user to copy a specific pricing worksheet along with the draft provider pricing clauses on the Pricing worksheet. This feature also enables user to override specific attributes on the draft provider pricing clauses at the time of copying.

4.25.1.0.3

NXT-31011

Access Restriction on Download Feature

This enhancement links the ability to download data from the JET user interface to a user role. Only users with access to the Download Data restriction grant can download data from JET UI using the download action.

Documentation Links:
Security Guide - User Access - Data Access Restriction Types - Download Data Restriction

NXT-31924

Disable Enrollment Callout on Claim

This enhancement introduces the ability to prevent the enrollment call out within the context of a single claim, controlled through a new indicator on the claim itself. If the indicator is set to true, and there is enrollment data attached (either from a previous processing or coming in with the claim) then the enrollment data is retained regardless of the timer settings / expiration and no new callout is performed.

Documentation Links:
Developer Guide - Integration Points - Claims In Integration Point
Developer Guide - Integration Points - Claims Update Integration Point
Operations Guide - Enrollment Callout - Gathering Enrollment Data
Operations Guide - Claims Flow - Flow Overview

NXT-31938

Ability to update episode details using UI

This enhancement introduces the ability to create, update or remove episode details for an episode using the user interface.

NXT-32413

Increase max rows displayed on reference sheet lines page

Number of Rows displayed is increased from 500 to 1500 for reference sheet lines. With this, scroll is supported upto 1500 records. Once 1500 lines are loaded, information message to refine search criteria is displayed

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

This section intentionally left blank.

Web Services

Ref Action Description

NXT-29960

Modified

Enrollment Integration Point

When a dynamic logic function of signature Enrollment Request Definition exists, the system uses the request definition for this function to do the enrollment callout. If there is no dynamic logic function with this signature, the system uses the standard enrollment request.

NXT-31924

Modified

Submit Claim

If the keep enrollment indicator is set to true, then no enrollment callout is done regardless of the timer setting / expiration of the enrollment data

NXT-31924

Modified

Claims IN integration Point

Keep enrollment data indicator is added to the payload on claim header level

NXT-31924

Modified

Claims Update integration point

Keep enrollment data indicator is added to the payload on claim header level

Data Conversion

Ref Action Description

NXT-31011

Added

OHI_ACCESS_RESTRICTION_GRANTS

The new access restriction will be provided to all non system active roles (with retrieve flag as Y), having at least a system function access grant with retrieve flag as Y

Dynamic Logic

Ref Action Description

NXT-29960

Added

Enrollment Request Definition

New dynamic logic function to construct the enrollment request including additional parameters

UI Changes

Ref Action Description

NXT-30992

Modified

CL0098 Pricing Worksheet Page

Copy worksheet drawer has been added in search and detail page.

NXT-32413

Modified

Referencesheetlines

Referencesheetlines table supports scroll up to 1500 lines.

Breaking Changes

Ref Action Description

NXT-31011

Added

OHI_ACCESS_RESTRICTION_GRANTS

JET (UI) will implement a new access restriction called "Download 'Data'" to manage the visibility of the Download button. Users who are not granted this access restriction will no longer see the download action, making this a breaking change.

Access Restrictions

Ref Action Description

NXT-31011

Added

OHI_ACCESS_RESTRICTIONS_B

A new access restriction of type DWDATA and code as UI_DATA_DOWNLOAD has been added. The same has been assigned to ALL_FUNCTIONS_ACCESS_ROLE

NXT-32481

Modified

CO0019

keyboardshortcuts API and floorplans.enhance IP added to CO0019 function code

Bug Fixes

BugDB SR Internal Summary

38106527

3-36700304951

NXT-31893

System randomly throws optimistic locking exception while updating dynamic logic on CFS deployments

Description:

In certain scenarios, updates made to dynamic logic were not immediately reflected at runtime because the internal cache reload process could occur before the relevant database transaction was committed. This timing issue could cause the cache to be repopulated with stale data.

Resolution:

The dynamic logic cache reload process is now triggered only when the update transaction is committed, ensuring that the cache consistently reflects the most recent changes.

38334412

NXT-32313

Pricing worksheets Validated by field shows Login Name instead of Display Name

Description:

After validating the pricing worksheet the last validated shows login name instead of Display Name.

Resolution:

Validated By field now shows the Display Name in advance search as well as detail page

38400781

NXT-32481

keyboardshortcuts API should be part of CO0019 function code

Description:

keyboardshortcuts API and floorplans.enhance IP should be added to CO0019 function code

Resolution:

keyboardshortcuts API and floorplans.enhance IP added to CO0019 function code and also removed duplicate access from setup access role

38340036

NXT-32342

Referencesheetline Search Not Working Correctly When Query Checks For NULL

Description:

Referencesheetline Search does not work with null search.

Resolution:

Null and NotNull operations are enabled and respective code changes have been done in JSON Query search

38426688

NXT-32514

Pend rule does not fire for subclaim after reprocessing a large claim

Description:

Pend rule is not reapplied to a subclaim when a large claim is reprocessed.

Resolution:

Resolved pend rules are cleared upon claim submission. During reprocessing of a large claim, pend rules can now be reattached to the subclaim.

38153449

3-42038432458

NXT-32005

Loading icon is not closed for a Claim record with one claimline when tried to save or submit the claim in result template

Description:

When result component is enabled for claim line tab on claims page, and only one record is present. In the expanded view mode, the loading icon is not closing and claim page is greyed out on submit action

Resolution:

Loading icon is closed after submit action

38433735

NXT-32551

Regime counters - Regime Counters and Regime Consumptions sections are not loading

Description:

Navigate to Regime counters page and fetch a Coverage regime counter. Click on view, System throws console error & Regime counters and consumptions sections are not loading

Resolution:

Regime Counter and Regime Consumption sections are loading without any errors

38376420

3-41859180203

NXT-32406

Diagnosis list order is not based on sequence

Description:

Diagnosis list order for claim,claim line, ctr claim and ctr claim line is not based on sequence for claims out IP.

Resolution:

Diagnosis list order for claim, claim line, ctr claim and ctr claim line is now sorted in ascending order based on sequence for claims out IP.

38131925

3-41237424921

NXT-31943

Duplicate entries in OHI_TABLE_COLUMNS

Description:

The table OHI_TABLE_COLUMNS keeps track of database columns which are marked as PII, but also if a column is subject to diacritics search options. Currently there are two entries for the 'NAME' from the relations table. One of the entries indicates diacritic search and PII for all subtypes, the other entry indicates that only relations of subtype 'PERS' are PII. As a result, when generating base views the system will either throw a Null Pointer Exception, or it will mark all the name of all subtypes of a relation as PII.

Resolution:

The duplicate entries as merged into a single entry with PII on subtype 'PERS' and diacritic search enabled. A similar action is taken on the duplicate DATA_FILE entry from the Data Files table.

37988876

3-40590957691

NXT-31703

Multi Value Dynamic Flex Codes & Dynamic Records are not getting displayed

Description:

When multi value dynamic flex codes and dynamic records are configured for existing form, the newly created fields are not reflecting under view mode.

Resolution:

Newly created multi value dynamic flex codes and dynamic records configured for existing claim form are reflecting under view mode

38210353

3-41416079331

NXT-32104

Fee-Schedule: duplicate records when downloading fee schedule lines

Description:

When downloading the Fee Schedule Lines data, the generated file contains duplicate records

Resolution:

Fix has been implemented to prevent duplicate records from appearing in the downloaded file from the table.

38350840

NXT-32367

eventDate attribute in logapplicationevents and logdynamiclogicevents resources ignores time component

Description:

The eventDate attribute in both logapplicationevents and logdynamiclogicevents resources ignores time component in Query API. So, the query criteria including a time component (e.g., 2025-06-15T14:30:00 are not honored. The system defaults to 00:00:00 as the time, effectively filtering by date only. Also, the response payload includes only the date portion, omitting time entirely.

Resolution:

The eventDate attribute is updated to honor the time component in Query API criteria. The response now also includes the time component (hours, minutes, and seconds). Fractional seconds (e.g., milliseconds) are not included in the response.

38328894

NXT-32301

Episode: Reimbursement Method value is not showing in episode details tab

Description:

On the Episodes page, under the Episode Detail tab, the Reimbursement Method value is not displaying

Resolution:

Updated the Episode Detail tab on the Episodes page to ensure the Reimbursement Method fields are now displayed correctly

38325326

3-41744023681

NXT-32293

Links component is not shown when one of the link has missing data

Description:

When one or more links configured in floorplan refers to a field with missing data, the entire links component is not getting rendered.

Resolution:

The scenario when a field configured has no data is handled now. This will ensure that the links that have missing data won’t be rendered. When none of the configured links is valid, the link component will not be rendered in the UI.

38341380

3-41902254921

NXT-32348

Claim Settle/Unsettle actions failing with the 501 method not implemented error

Description:

When attempting to settle or unsettle a finalized claim (with the settle button enabled) and after selecting a settlement reason, the request fails with a 501 method not implemented error because the Settle PATCH request is incorrectly formed—the resource should reference external claims data.

Resolution:

Settle and Unsettle actions now work as expected.

38406401

NXT-32492

Task remains stuck in PENDING status when not dequeued before expiry

Description:

Tasks are not retried automatically when a node failed to dequeue a task due to memory errors. As a result, tasks are left stuck in state '3’ in the queue. This needs manual intervention by marking the task status as 'ERRORED' and recovering the task using recovery API.

Resolution:

The 'max_retries' parameter is now increased to 5. This allows other healthy nodes to retry the dequeue operation, reducing the chance of tasks remaining stuck unless all nodes experience issues simultaneously.

38308421

3-41789118211

NXT-32275

Error saving service address while creating new rendering address in individual providers page

Description:

Navigate to individual providers page and create new rendering address row. There is an error while selecting service address from lookup or from dropdown. Issue is reproducible when there is only one title property configured in serviceaddress lov floorplan and organizationProviders lov is configured first in search properties.

Resolution:

Able to select service address dropdown and save rendering address row successfully with service address LOV floorplan configuration that has single title property and organizationProviders LOV configured first in search properties.

38250496

3-41452456228

NXT-32173

DPPC code generation issue

Description:

When DPPC is created without code, system sets DPPC id as code. But code should be set sequentially.

Resolution:

When a DPPC is created without a code, system sets a sequence of numbers starting from 001 as code. If a code consists of a string, the system generated sequence is attached as suffix.

38444623

3-42151456561

NXT-32582

Remove Message under More Dropdown is not Working in Claim Lines Tab on Claims Page

Description:

An error message appears on the Claims page when the Remove message option under the More dropdown is clicked in the Claim Lines tab.

Resolution:

No error appears on the Claims page when the Remove Message option is selected.

38424173

3-42026264111

NXT-32531

Date fields should be shown at the last in Reference Sheet Lines table

Description:

Sequence is applied for dynamic columns but Start Date and end date is not displayed at the last in Reference Sheet Lines table

Resolution:

Columns are sorted based on sequence and Start/End date are shown at the last

38449912

3-42142700911

NXT-32596

Claim Codes are not reflecting in limit consumptions of provider limit counters page

Description:

Claim codes are not displayed in Limit consumptions of Provider limit counters page

Resolution:

Claim codes are now displayed in limit consumption section

38009293

NXT-30409

Proper error message has to be returned during task purge process.

Description:

When task purge is initiated by directly calling ohi_task_purge_pkg.purge_data the purge functionality fails with error "ORA-02292: integrity constraint (OHI_CLAIMS_OWNER.OHI_TASK_ATTRIBUTE_FK2) violated - child record found".

The reason for this failure is ohi$user_constraints and ohi$user_cons_columns is not initialised with parent child table lists and columns which gets initialised only when triggered from ohi_data_purge_pkg.purge_data, This results in attempt to purge only parent table and since child table records are not purged yet ORA-02292 is raised. To avoid this we need to provide proper error message instead of ORA-02292 which is raised by oracle database.

Resolution:

When task purge is initiated by directly calling ohi_task_purge_pkg.purge_data, the purge functionality now fails with the error 'Operation not successful, use "Data purge package" to purge tasks'.

37987708

3-40770729791

NXT-31698

Claims search using a free field with reference is not working

Description:

When using the referenced field LOV (List of values) as lookup , the search action does not trigger any query and giving all the results irrespective of the selection

Resolution:

The search now correctly filters based on the chosen reference.

38434992

3-42122630601

NXT-32552

Row level error icon is not visible in fee schedule line tab

Description:

Error icon is not showing in row level whenever business rule error occurs in table component

Resolution:

Error icon is shown in row level and business rule error is shown when user hovers over it

38341949

3-41859557111

NXT-32352

Claim Line Edit Mode - No Option To Add Message, Pends To Line

Description:

In claim edit mode, user is unable to add messages and pend reasons to the claim line. Claim line level messages and pends are not displayed in the summary section.

Resolution:

In claim edit mode, messages and pend reasons can be added at the claim line level, and claim line level messages and pends are displayed in the summary section.

38257120

3-41336878131

NXT-32184

claim line benefit specification restart for a benefit specification with case definition is causing the other claim lines to be restarted.

Description:

  1. Benefit specification: VIVLG_ADV_INTER_C_00001- with case definition

  2. Benefit specification: VIVLG_MCA_INTER_C_00001 - without case definition. We start the claim line 1 and for that we get two benefit specification (BS) We evaluate the first BS and create the case adjudication and in the next step we remove this BS due to filtering on the provider group. Since we removed this BS we have to start the benefit evaluation again from claimline 1 but this time with only one BS without the case definition. After processing the first claimline we start processing the second line and for this we do the above process and we evaluate the case and remove the BS with case. The major difference is that instead of reprocessing the second line alone we start reprocessing from claim line 1. Because of this the number of times the case definition getting called for the claim line 1 is at the higher end and this number keeps on reducing until the last claim line.

Resolution:

Before we start filtering the benefit specifications for each claim, we make a copy of the benefit specifications so that we can restore them when any benefit specification which creates an adjudication case and then gets filtered out. The issue here is that when claim line 1 has a benefit specification which creates a case and then gets filtered out then we are removing this benefit spec only from the initial list, but the backed-up list still contains the benefit spec. When claim line 2 follows the above scenario we reset the benefit specs of the claim line 1 from the backed-up list which brings back the benefit specification that created the case and filtered out . This caused the looping issue - where the dynamic logic gets called in the 2 power (no of claim lines -1) times for claim line 1 and goes on.

To solve this issue, we are removing the benefit specification from the backed-up list. This will fix the calling of dynamic logic issues in the above sequence.

38198413

NXT-32095

Data transfer export to Oracle directory has issues with CSV and JSON formats

Description:

Data transfer export has issues: CSV output is invalid when string columns with commas are not escaped, JSON export returns empty values for CLOB columns exceeding 20MB, and JSON exports show only one file even when more records exist in the database.

Resolution:

Data transfer export now generates valid CSV output with escaped special characters, supports CLOB data in JSON format, and correctly reports the number of exported files.

38424210

3-42104010401

NXT-32534

Claim Line summary shows claim code instead of reservation claim code.

Description:

Claim Line summary shows claim code instead of reservation claim code and there is no link for reservation claim

Resolution:

Reservation Claim Code is displayed in the Claimline summary, along with a link to navigate to the Reservation Claim.

Issues that were backported in previous Release / Patch

No backports.