Payment Currency Conversion Provides Incorrect Results if First (ctr) Claim Line is Denied
Last updated on MARCH 08, 2018
Applies to:Oracle Health Insurance Claims Adjudication - Version 126.96.36.199.0 and later
Information in this document applies to any platform.
Claims payable to a provider have to be paid in the preferred currency of that provider. On claims where the first claim line is denied before the pre-benefits step, the financial transactions are always in the benefits currency. The transaction should be in the currency derived in the logic for the payment currency conversion. The logic with signature "Currency Conversion (Payment)" uses that preferred currency and the currency of the benefits amount to return the correct exchange rate.
That logic always uses the first ctr claim line as input, and depends on the benefits input amount currency. However; if the first claim line is denied before the pre-benefits step, the benefits input amount is null and no exchange rates can be found, resulting in an incorrect currency on the financial transactions. The expected result is to have the financial transaction in the correct currency, regardless of whether the first claim line is denied or not.
The workaround is to create a completely redundant dynamic field on the ctr claim line object and populate it with the currency of the product returned from enrollment (transaction scenario logic). In the payment currency conversion logic that field is used rather than the currency of the benefits input amount to return the appropriate exchange rate.
The issue can be reproduced at will with the following steps:
1. Create logic with signature Currency Conversion (Payment) that returns an exchange rate from the currency of the benefits input amount to another currency.
2. Make sure there are exchange rates present for the currency pair.
3. Process a claim, making sure that the first claim line is denied in a process step before the pre-benefits step and that other claim lines are payable.
Note that the financial transactions are created in the product/benefits currency and not in the "other" currency.
Payments for the affected claims may fail in production.
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