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ER - Provider Group as Parameter in Enrolment Product (Doc ID 2450110.1)

Last updated on SEPTEMBER 27, 2019

Applies to:

Oracle Health Insurance Enterprise Policy Administration - Version and later
Information in this document applies to any platform.



To reduce the number of "base products" for which the coverage/benefit is the same except there is a different network, it is necessary to be able to overwrite / enhance the product provider group (product network).

If the product provider group / specific provider groups could be set up in a similar way as parameters (enrollment call out to policies) this would reduce the number of products.

Two different group contracts might both be based on Enhanced Bronze, but one employer negotiated an extra organization provider to the product.
Having the ability to send "specific network" through policies, no extra product needs to be created.

It would even be better if it is possible to remove providers the same way through a specific network.

Desired solution: "Parameterization" type of solution for Product provider groups/specific networks of a product.


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