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 and later
Information in this document applies to any platform.


On production: 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.

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.

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

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


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