In Financial Message, The Claim Version Number Is Not At The Message Top Level (Doc ID 2248484.1)

Last updated on MARCH 31, 2017

Applies to:

Oracle Health Insurance Claims Adjudication - Version 2.16.1.0.0 and later
Information in this document applies to any platform.

Symptoms

On :  2.16.1.0.3 version, Processing


In Financial Message, the claim version number is not at the message top level  

In OHI 2.16.1 Financial Message, the claim version number is not at the message top level as message id and job id. It is at the claim header level.  When a subsequent claim version is a reversal only, there is no way to know what the adjustment version it is. Assumption cannot be made that it is the paid version + 1.

This issue is occuring for financial messages which are for a claim adjustment where the claim is being fully reversed. For example version1 paid $100.  Version 2 has fatal message changing it to pay $0. The financial message has version 1 in header in this case.  If similar claim is adjusted but is just paying the same or a different amount in new version, the financial message has the correct version number of 2. I am attaching an example of how a full reversal looked in 2.14, and how it is looking in 2.16.

2.16.1 FM should look the same as 2.14.1 in this regard, that is, at the message top level the current version number and previous version number should be displayed.

The issue can be reproduced at will with the following steps:
1) Load a claim in the system
2) Send in a subsequent claim version that is a reversal only
3) Review Financial Message

The issue has the following business impact:
Due to this issue, users cannot know what the adjustment version a claim is for subsequent claim versions that comes in as reversal only.

Changes

 

Cause

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