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Product Benefit Spec Not Generated Correctly if Product Service Definition Condition is Present (Doc ID 2458787.1)

Last updated on MARCH 25, 2019

Applies to:

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


On : version, Processing

If a product uses a service definition with a condition at the product service definition level, product benefit specifications for other products are not generated correctly.  The product benefit specifications refer to the benefit specifications with the condition, instead of the benefit specification without the condition.

For example:
Product UGCL uses service definition DENTAL_CONSULTATION with specific attributes, without a specific condition.
Product UGCL is generated with benefit specification OP_BD_DCON_C_00001

Product UGER uses service definition DENTAL_CONSULTATION with specific attributes, with specific conditions.
Product UGER is generated with benefit specification OP_BD_DCON_C_00006 and OP_BD_DCON_C_00007.

After the build of product UGER, a rebuild of product UGCL results in benefit specification OP_BD_DCON_C_00007.

Product UGCL should be built with a benefit specification without any additional logic, in the example above: OP_BD_DCON_C_00001.

Due to this issue, Products cannot be generated with the correct benefit specs; claims cannot be paid correctly.  Other urgent changes to products cannot be implemented.


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