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ZRG3004F: Reinsurance Yearly Deductible Not Applied (Doc ID 2114245.1)

Last updated on MARCH 08, 2016

Applies to:

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


On production: version, Usage

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 as expected.

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.


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