ZRG3004F: No Reinsurance Yearly Deductible (M-4383)

(Doc ID 2093398.1)

Last updated on JANUARY 04, 2016

Applies to:

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


On acceptance: version, Usage

Testing M-4383

When attempting to process a pharmacy claim in ZRG3004F,
the following error occurs.

Reinsurance of yearly deductible of the procedures with procedure code list 058 and 060 is incorrect.
For these procedures the reinsurance is not applied, just like for the medicine.

The issue can be reproduced at will with the following steps:
1. ZRG1201F: Configure the basic insurance with reinsurance for yearly deductible
1. ZRG1212F: Configure only coverage for medication (procedure X)
2. ZRG8050E: Import and process claim with 3 claim lines: procedure X and procedure Y (procedure code list 058) and procedure Z (procedure code list 058)
3. ZRG3004F: Process these 3 claim lines and notice that for the claim lines with procedures Y and Z no reinsurance is applied

The issue has the following business impact:
Due to this issue, users cannot correctly process these claims.


Sign In with your My Oracle Support account

Don't have a My Oracle Support account? Click to get started

My Oracle Support provides customers with access to over a
Million Knowledge Articles and hundreds of Community platforms