Relations Introduction

In Oracle Health Insurance a relation represents one single Persons or Organizations The application uses person records to store members, policyholders, contact persons and several other roles represented by a natural person. The application uses organization records to store employer organizations, reinsurers and several other roles represented by non-natural persons.

Persons and organizations share many common attributes and features, as they can fulfill the same role. For example, a beneficiary on a claim can be a person or an organization.

This page introduces the shared attributes, as well as those that are specific to the person only.

Shared Attributes

Identifiers

Every relation has a unique code as its primary assigned identifier. This identifier is either system generated or assigned by an external source upon creating the relation record.

In addition, you can attach any number of alternative identifiers to the relation. The application uses these alternative identifiers to recognize the relation with context of the intake process for claims and enrollment updates, when it fails to recognize the relation by its primary identifier.

Addresses

Every relation can store any number of addresses. Each address has a type, a start date and an end date. The available address types are user configured.
Examples of address types are a home address or a postal address.

Relation Links

A relation link represents an association between two relations. Each link has a type.
Examples are of relation types are parent-child, spouse-spouse and employer-employee.

Person Only Attributes

Demographics

All relation records have a name attribute. If the relation is a person, it stores several additional fields, including the person’s first name, title, name prefix / suffix, date of birth, gender and marital status.

Assigned Providers

A person can have one or more assigned providers. This represents an association between a person and a health care provider. Each assigned provider has a type, a start date and an end date.
Examples of assigned provider types are primary care provider or gynecologist.

Access Control

Relations are subject to several access controls. Some of these controls conceal the entire relation, while others conceal specific details only.

All relations have access controls on their line of business and on their alternative identifiers. To see a relation that belongs to a certain line of business, you require access to that specific line of business. This access control protects the complete relation record and all its details.

To see a relation’s alternative identifiers, you require access per identifier type. For example, to see a person’s social security number, you require access to the identifier type for social security numbers. This access control only protects the identifier values; other attributes on the relation record are not protected by this access control.

Persons have three additional access controls. The first conceals the complete person record, based on a user defined restriction that is more granular then the line of business restriction.
For example, an access control to conceal person records that belong to the payer’s employees.

The second control restricts access to a person’s address information. The third restricts access to other contact details such as phone number and email address.

Extensibility

Like all entities in Oracle Health Insurance, relations can be extended with customer specified attributes and details. Each customer specified attribute is subject to access controls.