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Waiting timerules including previous insurance periods are not evaluated correct (Doc ID 2052518.1)

Last updated on MARCH 09, 2017

Applies to:

Oracle Health Insurance Claims Management - Version 10.15.1.2 and later
Information in this document applies to any platform.

Symptoms

On acceptance : 10.5.1.2.3 version, Usage
Testing M-3383

ZRG3004F: Waiting time rules including previous insurance periods are not evaluated correctly

ERROR
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D-DVW0008: Qualifying period for procedure #1# (#2#, procedure type #3#) not met

STEPS
-----------------------
The issue can be reproduced at will with the following steps:
See attachment 'Former insured period not taken into account when validating waiting time rules'.

BUSINESS IMPACT
-----------------------
The issue has the following business impact:
Due to this issue, it is impossible to process claims for members with a previous insurance correctly. This will be done many times, because during the migration from the old system Osiris to the new system OHI we do not take all history of the members. To avoid calculating the waiting period again we register the previous insurance period to register the time frame that the member was already insured at Plan Seguro at the moment of migration.

Cause

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In this Document
Symptoms
Cause
Solution
References


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