Provider Groups

Provider groups (or 'Networks' in the U.S.A.) are groups of medical service providers that are used as a part of a product or product service definition in Oracle Health Insurance Product Definition to signify if a group of providers is eligible for that product or specific product service definition.

The product building blocks integration point allows provider groups to be created and updated in {prodComponent}. OHI Claims Adjudication and Pricing is designated as the system of record for provider groups. In Oracle Health Insurance Product Definition a provider group only contains identifying attributes as opposed to OHI Claims Adjudication and Pricing where the contents of the provider group are stored (the list of individual and organization providers associated with the group). Provider groups therefore do no have a dedicated screen in Oracle Health Insurance Product Definition and cannot be deleted or modified, as the grouping is not done in Oracle Health Insurance Product Definition.

Field	Description
UUID	Unique identifier across OHI modules
Code	The code for this provider group
Description	The description of the provider group
Active Indicator	Indicator if the new references can be created to the provider group

A user selects provider groups from a list of values when creating a product or product service definition.

When assigning a provider group to a product or product service definition it is possible to specify an assignment label. If such a label is specified OHI Claims Adjudication and Pricing will use the policy product provider group(s) with a matching assignment label when determining network status in the claims flow. An assigned provider group label has the following fields:

Field	Description
Code	The code for this assigned provider group label
Display Name	The display name of the assigned provider group label