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Pricer Deny Medi Paid Pend Is Not Populating when Medicare Paid for DME Claims (Doc ID 2525407.1)

Last updated on DECEMBER 03, 2019

Applies to:

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


The issue comes up if a claim has an amount in the Prec payer allowed amount field; the Pricer deny medicare paid pend is not populating for DME claims. Not all claims are getting the fatal message when run in batch.  All the claims are consider Medicare pd claims. Even if the prec payer allow field is blank, there is money in the prec payer pd or coin or ded field.

The expected behavior is that all the claims should all pend.

The issue can be reproduced at will with the following steps:
Process a claim with an amount in the prec payer allowed amount field with a rule set to pend claims for that.


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