Claim Holds are Getting Posted with Incorrect Transaction Source Code (Doc ID 2259489.1)

Last updated on APRIL 26, 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

Claim holds are getting posted with incorrect Transaction Source Code  

While posting a claims hold through Claims Hold IP, the valid transaction source code is 'ADHOC' but the claim hold is getting posted with other Transaction Source Codes like 'ADJ', 'COTIVITI' etc.
I.e., claim hold is being successfully posted with transaction source codes other than 'ADHOC'.
 

Claim hold should only be posted successfully with Transaction Source Code as 'ADHOC'.

The issue can be reproduced at will with the following steps:
1. Send in claims
2. Post a claims hold through the Claims Hold IP


The issue has the following business impact:  Inaccurate hold information is being put on claims making it hard for claims processors to determine the next steps.

Changes

 

Cause

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