Enrollment Files
An enrollment file holds information about policy enrollment data files that were loaded into Oracle Health Insurance Enterprise Policy Administration. It can store the handling dates, the number of policies and enrollments in the file, and identifiers of the loaded policies.
Policy Integration Point
When a Policy In Integration Point request holds an enrollment file name, the integration point stores that enrollment file and counts the number of policies and the number of enrollments that are in the request. The integration point also stores an enrollment file policy for every policy in the request with a count of the number of enrollments in that policy. If an enrollment file with the specified enrollment file name already exists, the integration point selects that enrollment file. If the request does not specify an enrollment file name, no enrollment file is created or updated.
The integration point sets the received policy count and the received enrollment count on the enrollment file. [1]
The Policy In Integration Point also sets the enrollment count per policy on the enrollment file policy.
When the request is a single policy request, the Enrollment File Name is part of the <policy> element.
The system creates no enrollment file entry if the request holds no Enrollment File name.
When the request is file-based, the Enrollment File Name is part of the 'write policies batch' request, that is at the level of the data file set.
The system creates no enrollment file entry if the request hold no enrollment file name.
When the request is file-based, the system ignores any Enrollment File Name specified at the <policy> element level.
This also applies if the batch request has no Enrollment File Name but a policy in that batch does have an Enrollment File Name.
The counts are set at the moment the processing of the request completes. For the batch request this means that the counts are set when all policies in all data set files of the data set have been handled.
When loading a policy raises a fatal error, the policy (and it’s enrollments) are not included in the counts and the system does not create an enrollment file policy for these policies. If all policies in a request raise a fatal error, the system will still create/update the enrollment file, but the total policy count and the total enrollment count will be empty.
When loading a policy or a batch file with an enrollment file name that already exists in the system, the counts are summed with the existing counts on that Enrollment File. This also applies when a policy or batch file is loaded without the /submit option and at a later moment the same data file with the same enrollment file name is loaded (with or without the /submit option).
Example
Step 1
The system loads a batch file with 100 policies, each policy with two enrollments. The enrollment file name for this batch is 'ABC1234'. After the first load the received policy count is 100, the received enrollment count is 200. There are 100 enrollment file policies for this enrollment file, the enrollment count on each enrollment file policy is 1.
Step 2
That same file is loaded a second time. After the second load the received policy count is 200, the received enrollment count is 400. There are 200 enrollment file policies (100 duplicates [2]) for this enrollment file. The enrollment count on each enrollment file policy is 1.
Step 3
The system loads a different batch file, now with five policies, each policy has one enrollment. Three out of the five policies were already present in the first batch file. One of these three policies has a new enrollment. The enrollment file name for this batch is identical to that of the previous file: 'ABC1234'. After this load the received policy count is 205, the received enrollment count is 405. 405 enrollment file policies exist for this enrollment file. There are 202 duplicates [2].
This behavior is intended to support the upload of a first primary file and after that the upload of additional policies, either by individual policy request or batch requests.
When uploading different versions of the same batch file and wanting the counts on the enrollment file reflect each separate file version, then use different Enrollment File Names for each version. For example by postfixing the enrollment file name with a version number.
The way the policy integration point handles enrollment files is identical for single policy request and batch file request. Also the handling of enrollment files is identical for policy in patch operations as for the 'normal' operations.
Using Enrollment Files as Input for Operations
The enrollment file name can be used as input parameter for the bulk update, the submit policy and the revert policy operations. If specified, these long running operations select the enrollment file policies listed under the enrollment file and start the operation for them. If the enrollment file holds multiple versions of the same policy, the operations only select the policies with the highest version number. If the enrollment file holds multiple entries of a policy with the same version number, it will process each policy only once.