ZRG3004F: Multiple Claims With Different Coverage are not all Calculated (Doc ID 2100626.1)

Last updated on MARCH 08, 2017

Applies to:

Oracle Health Insurance Claims Management - Version 10.15.2.1 and later
Information in this document applies to any platform.

Symptoms

On : 10.15.2.1 version, Usage

ACTUAL BEHAVIOR
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Situation: A claim with 3 lines where 2 lines are linked to a specific coverage and the last one is using a different coverage.
System is calculating the deductible and coinsurance for the first two lines but not for the last one.

EXPECTED BEHAVIOR
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Situation: A claim with 3 lines where 2 lines are linked to a specific coverage and the last one is using a different coverage.
System calculates coinsurance correctly in all lines it corresponds.

STEPS
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The issue can be reproduced at will with the following steps:
1. Create a claim including coinsurance
2. Use different coverages for the lines
3. Review coinsurance in the last line

BUSINESS IMPACT
-----------------------
The issue has the following business impact:
Due to this issue, there is incorrect payout to members.

Cause

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