Real Time Claims Invoicing

(Doc ID 2361618.1)

Last updated on FEBRUARY 15, 2018

Applies to:

Oracle Health Insurance Claims Adjudication - Version 2.17.3.0.0 and later
Information in this document applies to any platform.

Goal

ENHANCEMENT REQUEST:
=====================
Real Time Claims Invoicing

Currently the following functionality in OHI is only available in batch mode:
Creation of payable invoices (financial messages) for claims
Daman requires an asynchronous straight-through processing option where upon finalization of a claim the system would send out a financial message related to a new claim / claim update without the need for further intervention (e.g. select into set, supersede, etc.).
There may also be a requirement (to be verified) to have real-time (synchronous) processing of a claim through creation of a financial message to support on-line entry of reimbursement claims.
Note: The financial message related functionality would be essentially the same as is currently provided in batch (via financial message creation). Only the XML option would be provided. The solution would also need to handle failure so that it would be possible to regenerate invoices in case of a failure in handling a ‘sent’ invoice. The financial message structure should be the same between batch and the new options.
 

Solution

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