ZRG3004F: ELEMINACION DE DEDUCIBLE INCORECT IN COMBINATION WITH 100% COINSURANCE (Doc ID 2061208.1)

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: 10.15.1.2 version, Usage

ACTUAL BEHAVIOR
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Eleminacion de deducible does not work in combination with 100% coinsurance

Additional coverage of a 100% threshold does not work like expected.

EXPECTED BEHAVIOR
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100% payment of the amount.

BUSINESS IMPACT
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The issue has the following business impact:
he concept of costo preferencial ( see attachment ) is heavily used by the members of the Golden Salud product ( the product that has gone live 20 days ago ) and there are many members who by the additional coverage 'Eliminacion de deducible' ( see also attachment ). Right now we are not able to process claims related to both topics correctly.

Cause

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