ZRG3004F: Extent Rule Exceeded (M-4383) (Doc ID 2107962.1)

Last updated on MARCH 09, 2017

Applies to:

Oracle Health Insurance Claims Management - Version 10.15.1.4 and later
Information in this document applies to any platform.

Symptoms

On acceptance: 10.15.1.4 version, Usage

Testing M-4383

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

ERROR
-----------------------
Determination of extent amount for the procedures with procedure code list 058 and 060 is incorrect.
Together with the medication the total amount for the claim exceeds the amount configured in the extent rule.

STEPS
-----------------------
The issue can be reproduced at will with the following steps:
1. ZRG1212F: Configure only coverage for medication (procedure X), with extent rule with maximum amount 50
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 the total cost prize for the claim exceeds 50

BUSINESS IMPACT
-----------------------
The issue has the following business impact:
Due to this issue, users must manually correct all these claim lines.

Cause

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