Provider Limits Are Not Registering Consumption
(Doc ID 2354911.1)
Last updated on DECEMBER 04, 2019
Applies to:Oracle Health Insurance Claims Adjudication - Version 22.214.171.124.0 and later
Information in this document applies to any platform.
Provider limits that previously worked do not appear to be working anymore. For example, the consumption is not registered and the hyperlink to the consumption screen is not there.
The expected behavior is the limit consumption should be registered and once limit is reached the claimline should be denied, and the link to the consumption should be working.
The issue can be reproduced at will with the following steps:
1. Have a procedure with a provider limit of 2 per day.
2. Enter 3 claims with same member/procedure combination.
3. In the first claims OHI indicates it is counting to the limit, but looking at counters there is none.
4. The 3 claim should be denied but since there are no counters it is not denied.
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