ZRG3004F: Benefit Group Exclusion not Taken into Account (Doc ID 2087519.1)

Last updated on MARCH 09, 2017

Applies to:

Oracle Health Insurance Claims Management - Version 10.14.2.2 and later
Information in this document applies to any platform.

Symptoms

On production: 10.14.2.2 version, Service

When attempting to process a claim in ZRG3004F or using ZRG3009S, where a benefit group exclusion is applicable for the umbrella contract,
the following error occurs.

ERROR
-----------------------
The exclusion of the benefit group is not taken into account and the claim line is paid out.

Note: when applying a benefit group addition to the umbrella contract, the outcome is correct however.

STEPS
-----------------------
The issue can be reproduced at will with the following steps:
1. ZRG2047F: Configure an umbrella contract with a benefit group exclusion
2. ZRG3004F: Process a claim for this benefit group for a member with a policy under the umbrella contract
3. ZRG3004F: Notice that no error is returned for missing coverage

BUSINESS IMPACT
-----------------------
The issue has the following business impact:
Due to this issue, users cannot correctly process claims for which benefit group exclusions are applicable.

Cause

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