ZRG3004F: F-DVW0978 With Debtor Risk and/or Procedure Interdependency Rule (Doc ID 2091522.1)

Last updated on DECEMBER 22, 2015

Applies to:

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

Symptoms

On production: 10.15.1.2 version, Usage

When attempting to process a pharmacy claim with multiple claim lines that belong together,
the following claim error occurs incorrectly.

ERROR
-----------------------
F-DVW0979 This credit line has been disapproved because a credit line has not been provided for all debit claim lines that belong to the same procedure.
This error occurs if for one of the claim lines for the total amount debtor risk is applied due to yearly deductible.
This error also occurs when a procedure interdependency rule is applicable.

If the procedure interdependency rule and/or the debtor risk configuration is removed, the functionality works correct.

STEPS
-----------------------
The issue can be reproduced at will with the following steps:
1. ZRG3004F: Process claim line with yearly deductible for the whole amount and make sure debtor risk is applied and a procedure interdependency rule is in place.
2. ZRG3004F: Process claim line in same claim that belongs together with the first claim line and notice error 0979

BUSINESS IMPACT
-----------------------
The issue has the following business impact:
Due to this issue, users cannot correctly process all pharmacy claims.

Cause

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