ZRG7005F/ZRG3004F: Cost Price Incorrect For WM Procedures

(Doc ID 2117118.1)

Last updated on MARCH 16, 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 claim in ZRG3004F,
the following error occurs.

The cost prize is not automatically lowered to the claimed amount, if the claimed amount is lower then the configured tariff.
The set up for this is done in module ZRG7005F.

If the claimed procedure starts with 02/ then the outcome is correct, if the claimed procedure starts with WM/ then the outcome is not correct (cost prize is higher then the claimed amount)

The issue can be reproduced at will with the following steps:
1. ZRG7005F: Set up percentage of 99% for pharmacists
2. Set up procedures 02/X and WM/X, with equal benefits and tariffs
3. ZRG3004F: Process claim lines for both procedures.

The issue has the following business impact:
Due to this issue, users cannot correctly process WM? procedures.


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