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.

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
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

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

Additional Upgrade Steps for Installation

The following phases are defined: pre-upgrade: Application is still running. pre-undeploy: Application is stopped, but not undeployed. post-undeploy: Application is undeployed. Database is backed up. post-upgrade: Released upgrade script run is complete. post-deploy: New application is deployed, and is up and running.

Post-Upgrade phase

1. A new MDC (Mapped Diagnostic Context) field, user, has been introduced for security logs. To ensure this information appears in the security log file, update the log pattern for the securityAppender (which uses RollingFileAppender) to include the user MDC field.

   Example updated pattern:

   <appender name="securityAppender" class="ch.qos.logback.core.rolling.RollingFileAppender">
       <encoder>
           <pattern>%d{ISO8601} [ %t ] %marker %c - %m [user:%X{user:-N/A}] %n</pattern>
       </encoder>
       ...
   </appender>

2. Create a new securityDBAppender in SaaS deployments. This appender enables writing security logs to the database.

   Example Logback configuration:

   <configuration debug="true" scan="true" scanPeriod="60 seconds">
     ...
     <appender name="securityDBAppender"
               class="com.oracle.healthinsurance.loggingsupport.appender.impl.OhiSecurityLoggerAppender">
       <connectionSource class="ch.qos.logback.core.db.JNDIConnectionSource">
         <jndiLocation>jdbc/policiesUserOhiApplicationDS</jndiLocation>
       </connectionSource>
       <logType>security</logType>
       <bufferDir>/writable/log/storage/buffer/security</bufferDir>
     </appender>
     ...
     <root level="error">
       ...
       <appender-ref ref="securityDBAppender"/>
     </root>
   </configuration>

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

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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
CPN-4025	Modified	securityAppender A new MDC (Mapped Diagnostic Context) field, user, has been introduced for security logs. To ensure this information appears in the security log file, update the log pattern for the securityAppender (which uses RollingFileAppender) to include the user MDC field. Example updated pattern: <appender name="securityAppender" class="ch.qos.logback.core.rolling.RollingFileAppender"> <encoder> <pattern>%d{ISO8601} [ %t ] %marker %c - %m [user:%X{user:-N/A}] %n</pattern> </encoder> ... </appender> Also, security log messages now refer to the "login name" of the user instead of the "ID" of the user.

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.