ER: Provider Validation Checks
(Doc ID 2458789.1)
Last updated on FEBRUARY 03, 2019
Applies to:Oracle Health Insurance Claims Adjudication - Version 220.127.116.11.0 and later
Information in this document applies to any platform.
This requirement provides for doing a variety of checks on provider details and setting derived values based on those checks.
We need to be able to configure any check based on the details of a provider in OHI. This would be used to ensure there is only one ‘Active Period’ or ‘Contract Period’ active at any given point in time.
A provider ‘record status’ would be required to indicate if a provider had passed all validation checks since initial entry or the most recent changes. Upon changing provider’s details the status would be changed to indicate that validation is pending and the user would need to trigger validation when completed making the changes.
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