Conditions

Conditions are a type of user configurable logic where one or more objects are used as input with a result that is either true or false. The signature of a condition specifies which objects are required. In Oracle Health Insurance Product Definition conditions can be added to a service definition or product service definition to evaluate if it applies to a certain procedure, diagnosis or other claim line conditions during claims processing.

Three different types of dynamic logic conditions can be attached. Each of the types has a different signature: 'Diagnosis', 'Procedure' and 'Benefit Specification (Other)'. The first two are created and maintained in Oracle Health Insurance Product Definition. The dynamic logic with the signature 'Benefit specification (Other)' is created and maintained in Oracle Health Insurance Product Definition. The conditions integration point allows the conditions with the signature 'Benefit specification (Other)' to be imported in Oracle Health Insurance Product Definition and they are shown as view only.

In addition dynamic logic with the signatures 'Product Filter' and 'Validation Check' can be created in Oracle Health Insurance Product Definition. These signatures are Oracle Health Insurance Product Definition specific.

OHI Product Definition stores the following data of a condition.

Field	Description
UUID	Unique identifier across OHI modules
Code	The code for this condition
Description	The description for this condition
Signature	Diagnosis / Procedure / Other
Logic	The dynamic logic
Message	A reference to a message
Active indicator	Indicator if new references can be created to the condition
Indicator Universal	Indicates if the condition needs to be added to all benefit specification during export file creation. Only applicable to 'Benefit Specification (Other)' conditions.

If incorrect logic is submitted the message OHI-DYLO-007 will be returned.

Code	Sev	Internal message
OHI-DYLO-007	Fatal	Error occurred in dynamic logic {0} on line {1}: {2}

If such an entity message occurs during processing, that specific message is passed along and persisted in a log.