Limit of Service Days Raises a Limit Exceed Message on Claimlines with the Same Service Date

(Doc ID 2367146.1)

Last updated on FEBRUARY 28, 2018

Applies to:

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

Symptoms

A limit is set up with type service days and a reference treatment with a renewal period of 2 years.  The first claimline counting towards that limit is paying.  For subsequent claimlines with the same service date the limit exceeded message is raised.

The expectation is that subsequent claimlines with the same service date should not be considered as exceeding the limit.

The issue can be reproduced at will with the following steps:
1. Configure a limit of type service date, reference treatment and a renewal period of 2 years.
2. Configure a product benefit spec counting towards this limit with a maximum of 1 service day.
3. Process a number of claimlines with the same service date for that product benefit spec.

Because of this issue claims are not paying correctly.

Changes

 

Cause

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