Claim Holds are Getting Posted with Incorrect Transaction Source Code
Last updated on APRIL 26, 2017
Applies to:Oracle Health Insurance Claims Adjudication - Version 18.104.22.168.0 and later
Information in this document applies to any platform.
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.
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